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172 Cards in this Set
- Front
- Back
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what is the medical name for an ingrown toe nail?
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onychocryptosis
or uriquis incarnatus |
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what is the most like bug in onychocryptosis?
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staphylococcal
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should you treat an ingrown toenail with oral antibiotics?
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No
usually able to treat any coexisting bacterial infection with topical antiseptic e.g. Povidone-iodine 10% ointment |
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when might you consider use of Antibiotics with an ingrown toe nail?
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if there is frank suppuration from the lateral nail bed or if cellulitis is developing
you would use di/flucloxicillin or cephalexin |
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what are some of the causes and exacerbating factors in onychocryptosis?
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faulty nail trimming
constricting shoes poor hygiene |
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how can you prevent onychocryptosis?
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good foot and nail care
cut end of nail no the corner foot baths, avoid nylon socks change socks regularly sensible shoes |
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What are the surgical treatments for onychocryptosis?
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1. Excision of ellipse of skin
2. Electerocautery; large wedge of skin and granulation tissue removed so nail is free of skin 3. Skin wedge excision; dissect away all skin folds adjacent to nail Wedge of nail resection and phenolysation |
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what is a nonsurgical treatment for onychocryptosis?
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wet cotton wool bud under nail edge for up to 14 days
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what is the name of the red tablet "ferro-" something and what are the particulars?
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Ferro gradument
Ferrrous sulphate (20% Fe) 325mg (30tablets/bottle) |
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what are some of the effects of Fe ingestions
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increases capillary permeability
increases intravasclar permabiliy and increases vasodilation |
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what is the gross result when free Fe exceeds circulaion transferrin binding levels?
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toxcicity to the liver and other parenchymal tissues including the heart and lungs
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What is the first stage of Fe toxicity?
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1. GI stage; 0-6hours. abdominal pain, vomitting, GI haemorrhage
- fever, leukocytosis and hyperglycaemia are also associated |
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what is the second stage of Fe toxicity?
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2. Deceptive; 6-72 hours; reduction in Sx but metabolic acidosis begins and the beginning of end organ toxicity is beginnning
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what is the 3rd stage of Fe toxicity?
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3. metabolic acidosis, coagulopthy and hypovolaemic shock. Liver dysfunction and some patients have the return of GI Sx.
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What is the metabolic acidosis due to in Fe toxicity?
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- conversion of plasma Fe --> Feric Hydroxide = increase in H+
- Free radical damamge to mt membrane - Hypovolaemic and hypoperfusion cardiogenic shock |
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what is the fourth stage of Fe toxicity?
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4. GI scarring and acute obstruction occurs at roughly 4-6weeks later
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what does of Fe warrents medical attention?
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10-20mg/kg
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Fe: at what dose is it life threatening toxicity?
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>60mg/kg
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when should serum Fe be measured in suspected toxicity?
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at 2-4hours.
At >6hours liver has cleared most so will have misleading results. |
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what are the serum levels for Fe toxicity?
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mild 100-300ml/dL
mod 300-500ml/d/l severe >500ml/dL |
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what are the treatment options for Fe toxicity?
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deferoxamine IM 90mg/kg up to 1g or 10-15mg/kg/h IV
- Pulmonary oedema or hypotension may occur with high doses or rapid infusion AXR Lavage or whole bowel irrigation Ipecac (emetic) only with witness ingestion <30mins - not really used any more |
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what percentage of people >65 will experience at least 1 fall a year?
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30%
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what are some causes of falls?
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neuro/CVE
sensory/motor impairnment cardiovascular - postural hypotension MSK/gait/environment cognitive/psychological polypharmacy/medication |
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what are the questions you ask to guage someones EtOH use?
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how much
how often do you have alcohol free days? what type do you binge how long have you been drinking when was your last drink |
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what are the CAGE questions?
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C: ever felt like cutting down
A: ever been annoyed by friends asking you to stop? G: ever felt guilty for drinking E: do you need an eye opener in the morning? |
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what are the FLEMS questions of EtOH?
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F: financial
L: legal E: education/employment M: medical S: social ramifications |
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what need you ask to assess the dependency of the individual?
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tolerance
withdrawal Sx priority Loss of control compulsion to drink use despite knowledge of problem |
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what are some positive findings on a physical exam of a chronic alcohol user?
|
palmer erethema
duputyren's contracture parotid enlargement hepatomegaly investigations: BAC, LFT, FBC, EtOH withdrawal scale |
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what are some reasons a death must be reported?
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cause unknown
cause unnatural, violent, suspicious or unusual resulted directly or indrectly from an accident or injury (if <72y) in custody within 24hours of surgical proceedure not attended by a physician within 3months |
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what are the Ddx of a sore throat with exudate, fever, night sweats and tender cervical lymph nodes?
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Tonsilitis: bacterial or viral
pharyngitis quincy chemical irritation Cancer of the Tonsils |
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what would you find on examination of bacterial tonsilitis?
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sore throat, pain in swallowing referred to ears
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what suggests a viral tonsilitis?
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rihnorrhoea and cough
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what is suggestive of EBV tonsilitis?
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posterior cervical or generalised adenopathy
hepatosplenomegaly faltigue, malaise >1week full neck with petichiae of the soft palate, thick tonsilar exudates |
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what is suggestive of diptheria tonsilitis?
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dirty, grey, thick tough membrane that bleeds if peeled away
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what would examination show with quincy?
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peri-tonsilar abcess or cellulitis
pushes the tonsils medialy-inferiorly |
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what is the criteria for Group A beta haemolytic strep tonsilitis
|
1. Hx of fever
2. tonsilar Exudates 3. absence of cough 4. Tender anterior cervical lymphadenopathy <1 unlikely 1-2 investigation required 3-4investigations required, but should Rx empirically if pt very unwell |
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what are the investigations for tonsilitis?
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rapid antigen test: specific but not sensitive
Culture: 90% specific and sensitive |
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what is the treatment for tonsilitis?
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symptomatic treatment: analgesics, hydration and rest
ABs appropriate if all 4 diagnostic criteria for Strep infection are present - Penicillin V - Amoxicillin - Benzathine Penicillin IV if compliance is an issue if there is hypersensitivity to penicillin use Macrolide (roxithromicin) |
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Use of antibiotics in Aboriginals regarding Strep throat
|
- main rationate for treating strep thraot with ABs is to prevent rheumatic fever
- group A strep responsible for outbreaks in post-strep glomerulonephritis and acute rheumatic fever in indigenous populations. |
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briefly what is the pathophysiology of Acne?
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It is inflamation of the sebaceous glands of the skin
- increased sebum production secondary o increased androgen production - increased keratinisation of sebacieous ducts --> blocks the ducts = black- and white-heads - overgrowth of propioibacterium --> inflammation |
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What advice do you give a teenager with acne?
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do not squeeze
maintain a healthy diet avoid the sun dispell myths - it is not what you eat - it is not caused by oily hair - It generally clears by the age of 20 if not earlier |
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What are the treatments available to unblock pores?
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unblocking pores with keratolytics
1. sulphur compouds, salicylic acid (5-10%) 2. benzoyl peroxide (2.5, 5, 10%) 3. retinoic acid (tretinoin) gel (0.01%) cream (0.025, 0.05, 0.1%) 4. adapalene (Defferin) cream/gel |
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what ABs are used to treat inflamation and bacterial overgrowth associated with acne?
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systemic: Tetracycline, erythromycin
topical: clindamycin, erythromycin |
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What medication is there to decrease sebaceous gland activity?
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This is prescribed by a specialist.
1. oestrogen 2. spironolactone 3. cyproterone acetate 4. Isotretinoin (roaccutane) - teratogenic |
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What is the recommended regime for mild to moderate acne?
|
topical Rx
- tretinoin gel/cream (.01/.05%) OR - Isotretinoin .05% gel OR adapalene 0.1% NOCTE at 2 weeks Add Benzoyl peroxide (2.5 or 5%) MANE review at 3 months |
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what are some alternatives to keratinolytic topical treatment regimes for mild to moderate acne?
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- clindamycin HCl 600mcg in 60ml of 70% isopropyl alcohol OR
- Cetaphil lotion 100ml OR - Dermatech liquid OR - erythromycin 2% gel OR - adapalene 1% |
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how do you treat moderate to severe acne?
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with oral antibiotics
Tertrcycline doxycycline minocycline reduce dose according to response review at 12wks then 6 months |
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What is another treatment option for females with acne?
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using the combination OCP - best is containing 3rd generation progesterones
- cyproterone - despgesterol - dospirenone - gestidene |
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what is the Gillick case and the Gillick test?
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A parents authority decreases as a child ages
the test is to ask: there age level of independence level of schooling level of maturity ability to expres wishes |
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guadianship act of NSW says what?
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16 year old can consent to own treatment
a minor is <14-16 (vague area) |
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what are the contraindications for the OCP?
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Hx of thromboembolism, PE, CAD, CVA, HTN (uncontrolled), impaired LFTs, breast or genital tract malignancy. migraine with aura
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is the OCP available of PBS for acne treatment?
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no
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what are the adverse efects of Roaccutane?
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extreme risk of birth defects
adverse efects include; dry lips, dry hands, face, eyes and nose depression and suicidal thoughts |
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what is an absolutely contraindication for Roaccutane use?
|
pregnancy, intended pregnancy
Tetracycline use; --> benign intracranial HTN |
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what does the HEEADSSSS stand for?
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Home
Education/employment Eating Activitines; pear related Drug use/cigaretes Sexuality Suicidal/self halm safety spirituality |
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What are the indications for Xray of a swollen ankle?
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pain in the malleolar zone PLUS
1. bony tenderness along the distal 6cm posterior edge of tibia or tip of medial malleolus OR 2. bony tenderness alond distal 6cm of posterior edge of fibula or lateral malleolus 3. Inability to bear weight for 4 steps |
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what is the first aid care and physical manangement of swollen ankle?
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RICE + NSAIDs
- at 48-72 hours begin mobilising according to pain - PHysiotherapy referral; inadequate rehad = persistent Symptoms - At one week; if function is worse or yet to improve consider a grade 3 rupture; requires referral and MRI or arthroscopy to confirm; surgical treatment |
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why is mobilisation of swollen ankle so important
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because immobilisation leads to muscle atrophy
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What is Q fever?
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Q Fever:
A zoonosis due to Coxiella Burnetti; most common abettoir assocaited infection in Australia |
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what are the common resevoirs of Q fever?
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catle, sheep and goats
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how does Q fever infection result?
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Q fever infection results from inhalation ofspore-like cell variants and contact with any fluid of an infected animal (rarely is ticborne)
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what are the clinical features of Q fever?
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Incubation is 1-3 weeks
sudden onset of fever, rigors and myalgia dry cough (pneumonia is ~20% of cases) petechial rash (persistent infection) +/- abo pain |
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how long to symptoms of Q fever last?
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2-6 weeks;
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what is the result of persistent infection of Q fever?
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pneumonia
endocarditis (pt's with vavular disease particularly at risk) rare cause of hepatitis |
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how does Q fever resolve?
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rarely will spontaneously resolve
if untreated can be fatal however |
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What is the investigation plan of action for a person at risk of Q fever?
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serologically monitorred to assess changes in the phase 1 antibody assocaited with chronic infection and perform a baseline echo
serology should be repeated twice 6months |
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In Q fever serology is IgG is at 1:800 what does this indicate?
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that TOE should be performed
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if chronic infection is confirmed in Q fever what is the plan?
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serology every month and then 6 monthly post Rx cessation for two years, then yearly
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in Q fever what does a IgG of <1:200 indicate
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This is a good indicator of cure
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how do you diagnose Q fever?
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serodiagnosed by antibody levels in acute phase and then 2-3 weeks later
Acute: phase 2 antibody > phase 1 Chronic: Phase 1 antibody > phase 2 |
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what is the treatment for Q fever?
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Doxycycline 100mg bd 14days
--> but in chronic infection PLUS Rifampicin or hydrochloropuine and is prolongued therapy if endocarditis present: prolongued doxy + clindomycin or rifampicin in children <8y cotrimaxazole (instead of doxycycline) |
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What are the legal requirements of Q fever detection?
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it is a notifable disease
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what are the requirements for a health check?
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45-49y/o and risk of chronic disease
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what does a health check require
|
Long appointment:
1. information collection 2. overal health assessment and readiness to change 3. initiate interention 4. provide advice for lifestyle and behavioural change $102.20 item 717 |
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what is the 5A's strategy to smoking cessation?
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Ask and Id smoker every consultation
Advise on the risks Assess level of motivation to change Assist cessation arrange f/u 1week post quit date |
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what are the stages of readiness for smoking cessation
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not ready: clea non confrontational advice
unsure: discuss the pro's and con's = motivational interviewing Ready: offer encourangement and help formulate a quit plan Recently quite: offer congratulations and review and reinforce |
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Describe the pro's and cons of nicotine replacement
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- does not require a script (although patches are available of PBS now)
- suitable for psychiatric patients - can be used by 12-18 year olds - intermittent forms can be used in pregnancy and breast feeding * patch is irritating to the skin * expensive |
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Describe the pros and cons of Bupropion in smoking cessation
|
it is an atypical anti-depressant
useful for depressed not for patients w/ Hx of seizure Sx of psychosis and mania reported |
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What is Varenicline?
|
Champix!
it is the most effecacious smoking cessation too availble now >10% report nausea neuropsychiatric symptoms reported there is a lack of data on safety in CVD and COPD pts |
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in diarrhoea what are some important things to look out for on examination?
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dehydration, electrolyte inbalance, nutritional losses
muscle weakness (low K, low Mg, tetan, low Ca) bruising - low Vit K |
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what stool test would you perform if you had a high index of sus with a diarrhoea presentation?
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microscopy: parasites, looking for RBCs and WBC (warm specimen for amoebiasis [Entamoeba histolytica infection])
Culture: special request; campilobacter sp., C. Difficile., Yersina S., Cryptosporidium sp., Aeromonas sp., |
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with a severe case of diarrhoea what tests and investigations would you order?
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FBC, Iron, Ferritin, Folate, B12, Ca, electrolytes, TFTs, HIV
Anti body tests IgA antiendomysial, IgA transglutaminase for Coeliac disease Haemaglutination tests for amoebiasis C dificile tissue culture assay Malabsorptice studies endoscopy radiology: AXR |
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what is traveller's diarrhoea most likely due to?
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E coli
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if there is blood or mucous associated with a serious bout of diarrhoea what should you consider?
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amoebiasis
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if diarrhoea is persistent after travel to a eveloping country what should you consider?
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protazoal infection, amoebiasis (fever or blood) or giardisis (abdo cramps, flatulence and bubbly foul smelling stools)
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what is the treatment for diarrhoea?
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hydration with clear fluids until diarrhoea stopped
- consider antiemetic if there is also severe vomitting can try anti diarrhoeal prep - imodium preferred to this only attempt low fat foods once diarrhoea is resolved and avoid: cafffiene, alcohol, fat, spice food and dairy |
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confirmation of varicella Zosta comes how?
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with VZV IgM serum levels
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what is the treatment for VZ?
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analgesics
some use for antivirals; reduce severity and duration and risk of PHN (post-herpetic neuralgia) - must be admined within 72hours of onset, in a person >50 indicated or in someone immunocompromised Aciclovir 800mg 5/day for 7 days famciclovir 250mg 8hour for 7 days valaciclovir 1000mg 8hourly 7 days |
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what are the antiviral medication regimes use in Varcella zoser?
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Aciclovir 800mg 5/day for 7 days
famciclovir 250mg 8hour for 7 days valaciclovir 1000mg 8hourly 7 days |
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is herpes zoster contagious?
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only very mildly, a child can acquire the chicken pox after exposure
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if working with infants and children what vaccinations are recomended?
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Pneumococcal (5yearly) and pertussis
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what are teh catagories divisions of the glascow coma scale?
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>/= 8 severe
9-12 moderate >13 mild |
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what is PTA in terms of TBI?
|
well TBI is Traumatic Brain Injury
so PTA is post traumatic amnesia |
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what are some the socio-economic-psychological effects of a traumatic brain injury?
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unemployment/financial hardship
inadequate acedemic achievement lack of transport inadequate recreational opportunities Difficulty maintaining interpersonal relationships |
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what is "jobs in jeaopardy"?
|
a program designed to aid TBI and other disabled persons into the workforce
- interiew to assess capacity for work and for normal working hours - workplace assessment - organise workplace equiptment - determine suitable duties and monitor progress and aid returning to normal working hours liase with treating health profressionals follow up for 26 weeks once back at work full time in the maintenance phase. |
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what are 'pain' related yellow flags?
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1. belief backpain is harmful or potentially disabling
2. fear avoidance behaviour 3. low mood and withdrawal from social interaction 4. expectation that passive tretment rather than active engagement in treatment will help. |
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what are some psychosocial LT issues related to yellow flags of pain?
|
problems withs claims and compensation
Hx of back pain, time off and other claims Problems at work; poor job satisfaction RF heavy work or unsociavle workers unprotective family or lack of support |
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what are the 4 steps to a clinical assessment of pain?
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1. exclude red flags
2. ID neurological signs 3. assess functional limitations 4. determine the clinical management plan take a Hx including: - what activity --> pain - what does pain limit you in - what level activity = normal painfree lifestyle |
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are imaging investigations warrented if there are no red flags with back pain?
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no. until 4-6 weeks there is no benefit in absence of red flags
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what is a pain screecing tool that you can use?
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Orebro Musculoskeletal pain questionaire
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what is the aim of managing a backpain patient with no red flags or obvious pathology?
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return to work, normal duties, some analgesic may still be needed at normal duties
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what is the pathophys of residual pain in an amputated leg stump?
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injury to nerve fibres --> neuroma --> pain signals
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where does phantom limb pain originate
|
in the brain
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list some strategies for dealing with post amputation pain?
|
proper prosthesis fitting
physical therapy TENS: transcutaneous electrical nerve stimulation Sress management CBT NSAIDs antidepressants and neuroleptics oral opiods muscle reaxers |
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what is autonomic dysreflexia?
|
widespread reflex activation of SNS below level of SCI (>T6) triggered by ascending sensory stimulus
- overactivation of Symp ganglia - remains uncontrolled due to isolation of spinal cord from normal regulatation by vasometor centres in the brainstem. |
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what is a trigger of SNS stimulation in autonomic dysreflexia?
and what is the mechinism for S&Sx |
noxious stimulus --> NA and DA --> vasoconstriction (skin pallow), piloerection and sudden ^BP --> pounding headache
PSNS activity above SCI kicks in at ^BP sensed at baro receptors and carotid body --> bardycardia (via the vagus nerve) --> flushing from vessel dilatation in the head = flushed face and profuse sweating these mechanisms are insuficient to control paroxysmal HTN due to massive vasoconstriction of the splanchnic bed. |
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what are some causes of autonomic dysreflexia?
|
bladder distension, spastic bladder or UTI
kidney stones bowel changes Skin infection, ingrown toenail, burns, pressure areas irritants; fracture, epididymo-orchitis, sex, labour, menstrual cramping. |
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what is MGMT of autonomic dysreflexia?
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head above legs
loosen clothing bladder drainage monitor BPevery 2-5minutes may need a short acting antihpertensive (GTN) if HTN continues |
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what are the Ddx's for a purulent uretral discharge?
|
Chlamydia and gonorrhoea
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what are the 2 categories of male urethritis?
|
1. gonococcal
2. Non gonococcal - Chlamydia (most) - mycoplasma genitalium (requires prologued therapy) - ureaplasma urealyticum |
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what is the treament for non-gonococcal urethritis?
|
azithromicin or doxycycline
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what are some non-STI Ddx's of urethritis
|
idiopathic
Reiter's sydnrome (reactive arthritis associated with urethritis) trauma spermicides use UTI? usually urethritis not associated with LUTS |
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what investigations would you perform for urethritis?
|
dry swap for gram stain, culture and sensitivity
FCU (first catch urine): PCR and MCS |
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what does a full STI work up entail?
|
HIV with p24antigen test
RPR test to exclude syphilis - if chancrous lesions - PCR is faster HBc and HBs antibodies and HBsAg for HBV HCV antibodies and HAV IgM |
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Describe N, Gonorrhoeae
|
gram negtive diplococci - this is a diagnositic finding
|
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what does the presence of >5PMNs per HPF mean
|
not specific for gonorrhoea, but does confirm urethritis
|
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what is required to diagnose Chlamydia
|
NAAT on either dry swap (try first) or FCU for Dx
-->Urine MCS, direct microscopy and culture are too insensitive |
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In a sexual health screen what is recomended if no GN intracelular diplococci are seen
|
non-culture tests (NAAT) - more senstive and better 1ts line testing
can be used with urine, urethral, cervical, vaginal specimens - drawback is lack of specificity |
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what is the treatment for Gonorrhoea?
|
if you can assure compliance wait for sensitivities:
otherwise Ceftriaxone 500mg IV state combined with empirical treatment for NGU = azithromycin 1g PO state OR doxy 100mg bd 7days |
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describe the antimicrobial resistance to Neiseria Gonorrhoeae
|
changes in porin protiens of efflux pumps; destruction of antibiotics before reaching target sites, deletion or modification of the target site
|
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describe resistence relating to Penicillin
|
changes to penicillin binding proteins: which is the target of Beta lactam agents --> decreased binding affinity.
- mutation of PenB locus --> decreased permeabiliy to hydrophiloic antibiotics - Tem1 type Beta-lactamase hydrolyses beta lactam ring and inactivates the penicillin |
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role of cephalosporins in penicillin inactivity:
|
not all cephalosporins are hydrolysed by TEM1 type beta lactamase so 3rd generation are still efective
Cephalosporinases not yet detected in gonococci |
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|
Which STI are commonly transferred by oral sex?
|
Gonorrhoea
genital herpes syphilis |
|
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what STIs are rarely transfered by oral sex?
|
Chlamydia
HIV HepA-C genital warts Pubic lice |
|
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is there a link between HPV and pregnancy complication?
|
no
|
|
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in a pregnant women with HPV what is the neonatal risk of herpes
|
low
|
|
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what is the risk for neonatal herpes for a women with recurrent HSV?
|
<1%
|
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when is the highest risk of vertical transmission of HSV?
|
when the mother has not completely seroconverted by labour i.e., is a primary infection
50% of neonatal herpes if the primary infection was during the 3rd trimester |
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is there an increased risk of antenatal mortality or fetal malformation with asymptomatic HIV+ mother?
|
no
|
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In pregnancy what are some of the risks asociated with HIV?
|
small increase in spontaneous abortion
increase in low birth weight |
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when is the greatest risk of vertical transmission of HIV?
|
peripartum through direct contact of the birth
|
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with acute HBV what is the neonatal risk?
|
depends on the gestational age
- Transmission risk 80-90% in the 3rd trimester - 10% in the 1st trimester |
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What is the vaccination recomendation to women for women regarding HBV?
|
women of high risk should be vaccinated and Ig is recommended for neonates.
|
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are there any risks to pregnancy associated with Chlamydia?
|
yes. assocaited with prematurity and low birth weight.
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does transplacental transfer of maternal Chlamydial IgG pretect the foetus?
|
no
|
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what percentrage of foetuses directly exposed th chlamydial mother are infected?
|
~2/3
|
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what is a serious complication of a chlamydia infected mother to a neonate?
|
up to 50% develop infectious conjunctivitis
greater than 1/2 of those have a concurrent nasopharyngeal infection --> 30% will develop chlamydial pneumonia |
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What are the pregnancy risks associated with gonorrhoea?
|
increased prematurity
premature rupture of membrane low birth weight |
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when is the neonate likely to be infected with gonorrhoea?
|
in the perpartum period form direct exposure
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what is the gonorrhoea related complication in neonates without prophylaxis?
|
without prophylaxis 50% exposed go on to gonococcal opthalmia neonatum (this risk is increased with prolonuged rupture of membrane)
Gonoccocal sepsis is rare |
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what is the result of untreated maternal syphilis to the foetus?
|
most likely will infect the foetus
|
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what are some of the complications in pregnancy from syphilis?
|
premature delivery,
perinatal death: - ~ 50% of maternal primary/secondary infections - ~40% of early laten infection |
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untreated late syphilis results in what for the neonate?
|
around 10% evelop congenital syphilis and perinatal death increases by around 10%
|
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what are the differentials of an acute glandular fever like illness?
|
infections mononucleosis
tonsilitis aseptic meningitis primary HIV infection Acute CMV infection Toxoplasma gonaii infection diptheria common cold influenza leukaemia |
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what is the key past history to suspect HIV infection?
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glandular fever-like illness +
macular erythematous non-itchy rash; trunk, inner aspect of arm/legs sometimes palms and soles onset 2-6weeks after risky sexual behaviour |
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is the patient seroconvereted in the primary HIV infection
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no. by definition it preceeds serconversion
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i the primary HIV infection phase what tests can be performed?
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limited to viral antibodies - which may even present initially as borderline or even negative
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What is primary HIV infection characterised by?
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high plasma virus load
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what tests are used to diagnose HIV?
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two step process:
1. ELISA (combined detection of HIV antibodies and p24 antigen) - screening test 2. Western Blot - confirmation test |
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If an suspected HIV case has a negative ELISA what is the next step?
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unless there are very strong RF HIV is ruled out
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if the initial HIV ELISA screening test is indeterminant what is the next step?
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repeat the test.
- 2 subsequent negatives rules out HIV - If positive move on the Western blot |
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If an HIV patients has a postive ELISA screen but a negative western blot tests for HIV what does this mean?
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if it is negative this rules out HIV1
if it is indeterminant: repeat in 4-6weeks PLUS p24 cature assay, HIV1 RNA assay OR HIV DNA PCR PLUS specific HIV2 serological testing |
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If a suspected HIV patient has a positive ELISA, but a negative/inditerminant western blot what do further testing results indicate?
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negative p24 assay and HIV RNA rules out HIV
if either of the above are positive OR there is progression in the western bloc results - HIV is not ruled out. BUT diagnosis MUST be confirmed by a positive western blot |
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what is NOPEP
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Non occupational post exposure prophylaxis
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what is the requirement for NOPEP?
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candidates require baseline testing
for 3 drug regime must have a risk of >1/1000 for 2 drugs >1/10000-1/1000 for consideration of 2 drugs between 1/15000-1/10000 drugs must be prescribed within 72 hours of exposure 28 day course is recomended |
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what percentage of men and women with HPV are asymptomatic?
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50%
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describe a genital wart?
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firm, painless, whitsh, cauliflower-like surface
- can be flat fimbriate and pedunculated |
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what are the common sites for genital warts?
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underside of the foreskin
base of the penis vulval fourchette - also on cervix, vagina, anus (wmen), penis, scrotum and anum (men) |
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when is the highest incidence of genital HPV infection in women?
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15-24y
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when is the highest incidence on HPV infection in men?
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20-29y
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when is the peak rate of HPV for both men and women?
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20-29y
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when is the peak incidence of HPV in terms of an individuals sexualyl active years?
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within the first 5yrs of commencing
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how effective are condoms at prevening HPV spread?
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only 25-50%
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what is the lifetime prevalence of HPV?
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80%
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what is the probability of transmission of HPV per sex act?
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>60%
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for how long are you infectious?
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1 month
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list some risk factors for HPV and CaCervix
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age of 1st intercourse
number of partners multiparity hornomal contraception *Co infection with Chlamydia *Smoking *HPV |
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which herpes viruses does Gardasil vaccinate?
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6, 11, 16, 18
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which herpes viruses does cervarix guard against?
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16 & 18
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which are the 2 most important HPV strains in cervix cancer
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16 and 18
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what percentage of cervical cancer are 16 and 18 resonsible for?
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70%
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is cervical cancer more common in developed or developing countries
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most common cancer of women in developing countries
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