Week 2 part 2 Flashcards
What causes Acquired Immunodeficiency Syndrome AIDS?
HIV
What makes up AIDS?
- Opportunistic infections
2. AIDS related cances
What are the single highest predictor of mortality in HIV?
Aids related conditions
life ex[ectancy of HIV patinets?
Near normal
What type of virus is HIV?
Retrovirus
What type of HIV priginated from west african sootey mangabey (simian ID virus)?
HIV-2
What type of HIV 1 or 2 is less virulent?
Type 2
What HIV originated in central/west african chimpanzees and group M is responsible for starting global pandemic?
HIV-1
tARGET SITE for HIV?
CD4 receptors
What cells recognise MHC2 antigen presenting cell?
CD4 t lymphocytes
Name One major hallmark of HIV infection that promotes viral replication and drives CD4+ T cell depletion.
Chronic Immune Activation
Normal CD4 range?
500 to 1600
What CD4 count puts you at risk of opportunistic infections?
Less than 200
When does rapid replication of HIV occur?
Early and very late infection
When is a new generation of HIV replicated?
Every 6 to 12 hours
Within how many days is the HIV infection estasblished?
WIthin 3 days of entry
when does primary HIV infection present?
Onset 2-4 weeks after infection
Fever Rash (maculopapular) Myalgia Pharyngitis Headache/aseptic meningitis
Primar yHIV
What type of HIV infection is occuring with ongoing viral replication, ongoing CD4 count depletion, ongoing immune activation?
Asymptomatic HIv infection
an infection caused by a pathogen that does not normally produce disease in a healthy individual. It uses the “opportunity” afforded by a weakened immune system to cause disease
Opportunistic infections (occur in late disease with high viral load)
Wjhat organism causes pneumocystis pneumonia HIV?
Pneumocystis jiroveci
What is CD4 threshold in pneumocystis pneumonia caused by HIV?
lESS THAN 200
What sign is present in pneumocystis pneumonia?
Exercise desaturation
: insidious onset
SOB
Dry cough
Patinet with HIV?
pNEUMOCYSTIS PNEUMONIA
How is HIV causing PCP diagnosed?
Bronchoalveolar lavage and immunofluorescence
Treatment of HIV causing PCP?
High dose co-trimoxazole +/- steroid
prophylaxis - low dose co-trimoxazole
What are these more common in: Symptomatic primary infection Reactivation of latent TB Lymphadenopathies Miliary TB Extrapulmonary TB Multi-drug resistant TB Immune reconstitution syndrome
HIV posivie patients
In HIV what organism causes cerebral toxoplasmosis?
Toxoplasma gondii
CD4 threshold less than 150
HIV patient Multiple cerebral abscess (Chorioretinitis) Headache Fever Focal neurology Seizures Reduced consciousness Raised intracranial pressure
Cerebral toxoplasmosis (ring enhancing lesions on MRI)
cmv causes cytomegalovirus in HIV - what CD4 threshold is needed?
Less than 50
Retinitis, colitis, oesophagitis
Cytomegalovirus (presents with reduced visual acuity, floaters, abdo pain, diarrhoea nad PR bleeds)
If an HIV patient is getting multidermatomal and recurrent rashes what might it be?>
Herpes zoster
What organism causes HIV-associated neurocognitive impairment
HIV-1
HIV patient with reduced short term memory and +/- motor dysfunction?
HIV-associated neurocognitive impairment
What organism causes Progressive multifocal leukoencephalopathy
JC virus
What is CD4 threshold for JC virus?
Less than 100
HIV patient with rapidly progressing focal neurology, confusion and personality change?
Progressive multifocal leukoencephalopathy
Slims disease
HIV associated wasting
What organism causes aids related canacer kaposis sarcoma?
Human herpes virus 8
Name a tumour that is vascular?
Kaposis sarcoma
How is kaposis sarcoma treated?
HAART
systmeic chemotherapy
What aids related cancer does EBV cause?
Non-Hodgkins lymphoma
B symptoms
Bone marrow involvement
Extranodal disease
increase CNS involvement
Non-hodgkins lymphona - aids related
What virus causes aids related cancer cervical?
Human papilloma virus
Name some non-OI symtpomatic HIV complaints
Oral thrush Seborrhoeic dematitis Diarrhoea Fatigue Worsening psoriasis lymphadenopathy parotitis Hep B,C
Name two haematologic manifestations of HIV
Anaemia
Thrombocytopenia ITP
nAME four factors increasing HIV transmission risk
- Anoreceptive sex
- Truama
- Genital ulceration
- Concurrent STI
nAME 3 mother to child modes of transmission/
In utero/trans placental
Delivery
Breast feeding
What risk group has the highest proportion of HIV in UK?
MSM
Who should be tested for HIV
Universal testing in high prevalence areas
Opt out testing in clinical settings
Screening of high risk groups
Testing in presence of clinical indicators
Which markers of HIV are used by labs to detect infection?
RNA viral genome
Capsulse protein p24 (antigen)
Envelope proteins gp120
Antibody
When HIV seroconversion is taking place what is tested for?
Viralk load and p24 antigen
When HIV is in chronic infection stage what is best tested for?
Antibody
how long is window period (have infection but test negative) for antibody HIV testing?
3 months
For fourth gen HIV tests (combined antibody and antigen p24) what is window period?
14-28 days
What is a POCT
Rapid HIV test - results within 20-30 minutes
What could be used to identify if an HIV infeciton occured within preceding 4-6 months?
RITA - recent infection testing algorithm
what therapy is used for HIV treatment?
Anti-retroviral therapy ARV
What is reverse transcriptase, integrase, protease, entry and maturation all targeted by?
HIV antiretroviral drugs
What does highly active anti-retroviral therapy contain?
A combination of three drugs from at least 2 drug classes to which the virus is susceptible
Name three HIV HAART drugs?
- Tenofovir
- Emtricitabine
- Efavirenz
2 side effects of efavirenz
mood and psychosis
Renal side effedcts of HAART
Proximal renal tubulopathies
Bone side effects of HAART
Osteomalacia
What drug drug interactions must be thought of for HIV
NNRTIs are generally potent liver enzyme inducers so be careful of OCP
hOW DO you prevent mother to child transmission?
Vaginal delivery if undetected VL
HAART during pregnancy
PEP for neonate
Exclusive formula feeding
wHEN should chlamydia and gonorrhoea be tested for?
2 weeks following exposure
What is the incubation period of urethral infection in men for gonorrhoea?
2-5 days
For microscopy of gonorrhoea is urethral or endocervical more sensitive?
Urethral 90-95% sensitivity
treatemtn of gonorrhoea?
IM ceftriaxone and oral azithromycin
incubation of genital herpes
3-6 days
Blistering and ulceration of the external genitalia Pain External dysuria Vaginal or urethral discharge Local lymphadenopathy Fever and myalgia (prodrome)
genital herpes
is viral shedding higher in hsv1 or 2?
HSV 2
PRIMAR YSYPHILS INCUBATION?
9 to 90 days mean of 21
painless primary chancre?
Syphilis
Incubation period is 6 wks to 6 months
Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalized Lymphadenopathy
Patchy Alopecia
Condylomata Lata (most highly infectious lesion in syphilis, exudes a serum teeming with treponemes)
Secondary syphilis
What four conditions do not need partner notification?
Warts
Herpes
Vaginal thrush
Bacterial vaginosis
Name the four structures of female body in the pelvic cavity?
- Ovaries
- Uterine tubes
- Uterus
- Superior part of vagina
Name the 5 structures of female body in perineum?
- Inferior part of vagina
- Perineal muscles
- Bartholin’s glands
- Clitoris
- Labia
In female body where does excess abnormal fluid within peritoneal cavity tend to collect?
Within pouch of douglas
In females, how can fluid in the pouch of douglas be drained?
Needle passed through posterior fornix of the vagina
What is formed from a double layer of peritoneum and helps maintain the uterus in its correct midline position?
Broad ligament
What is contained in the broad ligament?
Uterine tubes and proximal part of round ligamnet
What is an embryological remnant and attaches to the lateral aspect of uterus?
Round ligament
What does round ligament pass through to attach to the superficial tissue of female perineum?
Deep inguinal ring
What are the three layers of support for uterus?
- Uterosacral ligaments
- Endopelvic fascia
- Muscles of pelvic floor
The most common position of uterus is when cervix tipped anteriorly relative to axis of vagina - what is the term for this?
Anteverted
What is a retroflexed Uterus?
Uterus tipped posteriorly relative to axis of cervix
What is sampled during a cervical smear?
Squamo columnar junction (transformation zone)
What do fimbriae at end of uterine tubes open into?
Peritoneal cavity
What are almond sized and shaped structures located more laterally in the pelvic cavity?
Ovaries
In post-pubertal emales where is the monthly ovum released directly into?
Peritoneal cavity - to be picked up by fimbriae
Where can ischial spines be palpated on vaginal digital exam?
4oclock and 8 o clock positions
Shallow space between pelvic diaphragm and skin?
Perineum
What merve su[pplies levator ani?
Nerve to levator ani - from S3,4,5
wHAT SUPPLIES (nerve) perineal muscles?
Pudendal nerve
What is the perineal body?
Bundle of collagenous and elastic tissue into which the perineal muscles attach
Important to pelvic floor strength
Can be disrupted during labour
Located just deep to skin
What ribs does the bed of breast extend from?
ribs 2 to 6
and lateral border of sternum to mid axillary line
Whjat do bed of breast lie on?
Deep fascia covering pec major and serratus anterior
What lies between fascia and breast?
Retromammary space
