Exam 4 real

NAAT and culture

what is used for diagnosis of gonorrhea

gonorrhea

urethritis, cervicitis, and pharyngitis are the clinical syndromes of ___________

ceftriaxone 500mg IM

what is the treatment of uncomplicated gonorrhea if

ceftriaxone 1gm

what is treatment of uncomplicated gonorrhea if >150kg

doxycycline 100mg bid x 7 days

what do you add to gonorrhea treatment if you aren't sure if the patient also has chlamydia or not

gentamicin + azithromycin

what are alternatives to gonorrhea treatment if cephalosporin allergy

cefixime 800 mg single dose

what can be used for gonococcal infection treatment if ceftriaxone administration is not available

cultures then susceptibility testing

after undergoing gonorrhea treatment, if a NAAT test comes back positive, what is next step?

if patient tests positive for gonorrhea, you should test the most recent sex parterns that have been in sexual contact with infected patient ________ days preceding onset of symptoms or gonorrhea diagnosis

most recent sex partner

if patient tests positive for gonorrhea but last sexual exposure was >60 days before onset of symptoms, who should you treat>

cefixime 800 single dose

what is treatment for sex partner if patient tested positive for gonorrhea

cefixime 800 mg plus doxcycline 100mg bid x 7 days

how should you treat sex partner if patient tested positive for gonorrhea and if a chlamydia test result has not been doxumented

azithromycin 1 gm

if adherence with multiday dosing is problem for sex partner, what treatment option can be considered? (is less effective in those with rectal chlamydia tho)

rimary

which stage of syphilis is this: painless chancre

secondary

what stage of syphilis is this: disseminated, condylomata lata, rash on palms and soles

tertiary

what stage of syphilis is this: gummas, aortitis, neurosyphilis, argyll robertson pupil

benzathine penicillin G 2.4 M units IM x1

what is treatment for early stage of syphilis

benzathine penicillin G 2.4M units IM weekly x 3

what is treatment for late latent or tertiary w/o CNS stage of syphilis

aqueous crystalline penicillin G 18-24m units IV q 4h x 10-14 days

what is treatment of neurosyphilis

doxycycline and ceftriaxone

what are alternative for PCN allergy in syphilis treatment

azithromycin 1 g PO x1, ceftriaxone 250 mg IM x1

what is chancroid treatment

chlamydia

often asymptomatic, major cause of PID and ectopic pregnancy fertility

doxycycline 100mg po BID x 7 days

what is first line treatment of chlamydia

azithromycin 1 g po x 1

what is alternative and pregnancy safe treatment for chlamydia

levofloxacin 500 mg x 7 days

what is backup treatment for chla,ydia

doxycycline 100 mg bid x 7 days, then moxifloxacin 400mg daily x 7 days, then

what is treatment of mycoplasma genitalium if testing not available or available with macrolide resistance

mycoplasma genitalium

resistance to macrolides and quinolones common in ___________

mycopalsma genitalium

persistent/recurrent urethritis, mainly anogenital; in femal: PID, cerviciitis, and vaginitis

doxycycline 100mg bid x 7 days followed by azithromycin initial dose 1g x 1 day then 500 mg day 2-4

mycoplasma second line therapy

extended azithromycin

mycoplasma genitalium treatment in pregnancy

minocycline 100 mg bid for 14 days

what is another option of mycoplasma genitalium treatment

foscarnet

what is used for treatment of genital herpes if there is resistance

acyclovir, valacyclovir, or famciclovir

what is treatment for genital herpes (HSV-1, HSV-2)

9-26 years old

what is age range for HPV vaccination

gardasil 9 vaccine

whatvaccine is used in HPV vaccine treatment

imiquimod, podofilox, cryotherapy

what are the treatment options of HPV (just list drugs)

false (avoid)

true or false: Gardasil 9 vaccine (HPV vaccine) is ok to give in pregnacy

hepatitis C

curative DAAs (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir) is the treatment for

hepatitis B

antivirals for chronic infection is used in __________ treatment

metronidazole 500 mg bid x 7 days

what is treatment of trichomonas vaginalis in females

metronidazole 2 g po x 1

what is trichomonas vaginalis treatment in males

tinidazole 2 g po x 1

what is 2nd line treatment of trichomonas vaginalis that is ok in men and women

metronidazole 500mg , metronidazole gel, clindamycin 300mg, clindamycin gel

what are the 4 treatment options for bacterial vaginosis that are NOT STD

doxycycline and quinolones

which lines of therapy should be avoided in STI treatment in pregnancy

chalmydia/gonorrhea therapy

what therapy is recommended for 23F with mucopurulent cervicitis

mycoplasma

23M with mucopurulent urethritis could be indicative of what disease

secondary syphilis

if 32M MSM has rash on palms and soles, what disease is suspected?

HSV suppressive therapy

45M HIV+ with recurrent genital ulcers, what is recommended

metronidazole 500mg bid x 7 days

26F recurrent trichmoniasis treatment

binding, fusion, reverse transcription, integration, replication, assembly, budding

put in order the HIV life cycle using these simplified terms:

fusion

replication

reverse transcription

binding

budding

assembly

integration

CD4

in HIV life cycle, HIV enveloped birion with glycoprotein 120 binds ____

CCR5 and CXCR4

in HIV life cycle, controntation changes of gp120 binding with CD4 with expose co-receptors _________________

viral and host membrane

in HIV life cycle, the exposure of CCR5 and CXCR4 trigger GP41 mediated fusion of ______________

viral capsid

the fusion of viral and host membrane in HIV life cycle leads to ___________

high VL, CD4 drops

describe VL and CD4 in acute HIV infection

stable VL, decline in CD4

describe viral load and CD4 in chronic HIV infection

what is CD4 count in AIDS

antiretroviral therapy (ART)

CD4 may increase x50-150 in feirst year, then 50-100 each year until steady state occurs during ________

CD4 count

_______ measures immune system health by tracking T-lymphocytes

viral load

________ measures amount of HIV in the blood and is the primary tool for monitoring the effectiveness of ART

a, c, d, g, h

which of the following drugs are NRTIs:

a. tenofovir

b. doravirine

c. emricitabine

d. lamivudine

e. efavirenz

f. rilpivirine

g. abacavir

h. zidovudine

b, e, f

which of the following drugs are NNRTIs:

a. tenofovir

b. doravirine

c. emricitabine

d. lamivudine

e. efavirenz

f. rilpivirine

g. abacavir

h. zidovudine

b, c, e, h, j

Which of the following are integrase inhibitors:

a. fostemsavir

b. bictegravir

c. dolutegravir

d. ibalizumab

e. elvitegravir

f. maraviroc

g. leronlimab

h. raltegravir

i. enfuvirtide

j. cabotegravir

a, d, f, g, i

Which of the following are entry-I/attachment medications:

a. fostemsavir

b. bictegravir

c. dolutegravir

d. ibalizumab

e. elvitegravir

f. maraviroc

g. leronlimab

h. raltegravir

i. enfuvirtide

j. cabotegravir

lenacapavir

which HIV med is a capsid inhibitor

ritonavir and cobicistat

what are the HIV med enhancers (2)

chain termination

what is MOA of NRTIs

allosteric RT inhibitor

what is MOA of NNRTIs

block biral maturation

what is MOA of PIs

prevent proviral DNA integration

what is MOA of INSTIs

dolutegravir + emtricitabine

what is first 2 drug regimen of HIV treatment

cabotegravir/rilpivirine

which HIV medication regiment is needed to acheive virologic suppresion with other regimen prior to starting combo

2 NRTIs

what is backbone treatment of HIV

a or b

emtricitabine/tenofivir alafenamide is paired with which integrase inhibitor as a preferred HIV medication treatment regimen:

a. dolutegravir

b. bictegravir

c. elvitegravir

d. raltegravir

a

lamivudine/abacavir is paired with which integrase inhibitor as a preferred HIV medication treatment regimen:

a. dolutegravir

b. bictegravir

c. elvitegravir

d. raltegravir

darunavir

an alternative HIV medication regimen includes tenofovir alafenamide/emtricitabine with which PI>

start within 2 weeks

when should HIV treatment be started if patient has TB when CD4 count

within 8 weeks

if patient has TB, when should ART therapy be started if CD >50

cabenuva

what treatment is considered in virologically suppressed patients with viral load

1st line induction two weeks with Amphotericin and flucytosine

What is primary treatment of crypto meningitis?

oral azole therapy

what is treatment of crypto pneumonia?

390 kcal, PPI

rilpirine needs to be taken with ______ and is contraindicated with _______

PIs and NNRTIs

which HIV drug classes are CYP inducers/inhibitors

INSTI + 2 NRTIs

what is first line treatment of HIV in most patients

cations

integrase inhibitors interact with ______ and should be taken at a different time

TMP-SMX

what should be given in opportunistic infection prophylaxis in HIV

TDF/FTC or TAF/FTC (men only)

what is PrEP in HIV

cabotegravir

what is the long-acting injectable in PrEP that is given every 2 months

TDF/FTC + DTG

what is the 3 drug regimen for PEP

>13 yo

cabotegravir in PrEP can only be given to those ______ (age)

engerix

which HIV vaccine has usual dose of 20

>18 yo

lenacapavir in PrEP can only be given to those _________ (age)

heplisav

if pt received engeric or recombivax vaccine and not effective, switch to

week 24

if already received 2 doses of heplisav, you can consider 3rd dose at ______

false (consider revaccination once CD4 is above 200)

true or false: if CD4 less than 200, consider revaccination right away

heplisav

if patient does respond to initial three doses of engerix, try to give 2 doses of _______ (month 0, 1)

ag/ab

HIV starts with screening testing 4th generation _______

HIV AB 1,2 differentiation test

if 4th generation screening of ag/ab is positive, what is next

PCR Viral NAT test

HIV AB 1,2 differentiation test come back as both NOT positive, what would you consider doing to test viral load?

twinrix

which vaccine is for hep A and B