NLE Immune System & Immunologic Disorders — Autoimmune Disorders and HIV/AIDSMemory Anchors

Memory aid

Picture a beautiful MARIPOSA (butterfly) landing gently on a woman's face — its wings rest exactly on both cheeks and the body sits on the nose bridge, but the wings do NOT touch the creases beside the nose (nasolabial folds). The butterfly avoids the folds like it is afraid to wrinkle its wings. Every time you hear 'SLE,' instantly see that mariposa face.

Why it works

Visual imagery using the Filipino word 'mariposa' (butterfly) creates a dual-language anchor that is both culturally familiar and anatomically accurate. The detail about sparing nasolabial folds is embedded in the image itself.

Example usage

Question: 'A 25-year-old woman presents with a rash across both cheeks and nose bridge. Which disease is most likely?' → Think: mariposa face → butterfly rash → SLE.

Recall trigger

Mariposa on the face

Memory aid

Remember: 'ANA is the SCREENING MAMA — she sees everyone (sensitive). But anti-dsDNA and anti-SM are the STRICT TITAS — they only point to SLE (specific).' The strict TITA SMITH only hangs out with SLE patients. The DNA tita tracks how ANGRY the disease is (disease activity).

Why it works

Using Filipino family archetypes (mama = sensitive, tita = strict/specific) creates an emotionally resonant social analogy. The 'Tita Smith = anti-Sm' directly links the name to the concept. Disease activity link for anti-dsDNA is embedded in 'how angry she is.'

Example usage

Question: 'Which antibody is MOST SPECIFIC for SLE?' → Think: Strict Tita Smith → anti-Smith. Question: 'Which antibody tracks disease activity and nephritis?' → Tita DNA tracks how angry SLE is → anti-dsDNA.

Recall trigger

Strict Tita Smith

Memory aid

Use the acronym: SIS FPD — 'Ate SIS, nag-FaPeD!' (Sister faded!)
S — Sun/UV exposure
I — Infection
S — Stress
F — Fatigue
P — Pregnancy
D — Drugs (and discontinuation of steroids)
Picture your 'Ate Sis' looking tired (faded) after being out in the sun at a barrio fiesta while stressed and pregnant — she caught an infection and forgot her meds. She FADED.

Why it works

The Filipino 'Ate Sis' story combines cultural context with a visual narrative that includes all six triggers in one memorable scene. The acronym SIS FPD is phonetically memorable as a phrase.

Example usage

Question: 'Which factor is MOST LIKELY to trigger an SLE flare in a young woman?' → Recall Ate Sis FaPeD → Sun, Infection, Stress, Fatigue, Pregnancy, Drugs — choose from these options.

Recall trigger

Ate Sis nag-FaPeD

Memory aid

Think of hydroxychloroquine as a SILENT THIEF that sneaks in and slowly steals your eyesight without warning. Just like how you install a CCTV camera at home to catch a thief before he steals everything — the eye doctor is your CCTV. Regular eye exams = surveillance camera for retinal toxicity. No camera → thief steals your vision before you notice.

Why it works

The thief-and-CCTV analogy makes the reason for monitoring (early detection before irreversible damage) immediately logical, not just a fact to memorize. Relatable home-security context resonates with Filipino students.

Example usage

Question: 'A patient with SLE is starting hydroxychloroquine. What monitoring is ESSENTIAL?' → Think: silent thief needs CCTV → baseline and periodic EYE EXAMINATIONS.

Recall trigger

Hydroxychloroquine = silent eye thief, eye exam = CCTV

Memory aid

CREST — already an acronym, but make it stick with a story: Imagine climbing a MOUNTAIN CREST in Benguet during cold weather. Your fingers turn WHITE then BLUE (Raynaud from cold), your skin is so TIGHT you can barely hold your trekking pole (Sclerodactyly), you see LITTLE RED DOTS on your hands (Telangiectasia), you feel CALCIUM LUMPS under your skin (Calcinosis), and you can't swallow your trail food because your esophagus stopped working (Esophageal dysmotility). Cold mountain CREST = all five findings.

Why it works

Setting the story in Benguet (a cold Philippine highland) makes it culturally grounded and memorable. Each finding is concretely described as a sensory experience during the trek, creating a vivid episodic memory.

Example usage

Question: 'Which cluster of findings is associated with the LIMITED form of systemic sclerosis?' → Think: cold CREST hike → Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia.

Recall trigger

Cold mountain CREST in Benguet

Memory aid

Maria had scleroderma. Her skin was so tight she looked like she was wrapped in cellophane. Her doctor warned her about her lungs — 'Maria, the REAL enemy is not your tight skin. It is your lungs turning to stone.' Her skin tightened her fingers, but her lungs — slowly becoming fibrous and stiff — were the silent killer. She could no longer climb stairs. Her last breath was not from tight skin. It was from lungs that could no longer expand. The real KILLER in scleroderma wears a lung mask.

Why it works

A micro-story with an emotional arc (the reveal that lungs, not skin, are the real threat) creates a surprise-based memory hook. The 'lungs turning to stone' metaphor accurately represents fibrosis and is visually memorable.

Example usage

Question: 'What is the LEADING CAUSE OF DEATH in scleroderma?' → Think: Maria's lung mask → pulmonary fibrosis and pulmonary hypertension.

Recall trigger

Lungs turning to stone — real killer in scleroderma

Memory aid

Remember Sjögren's as the 'DRY SYNDROME' using: DMA — 'Dry na ang Mata at bibig, Arthritis pa!' (Dry eyes and mouth, plus Arthritis!) For the antibodies, remember: 'SSA = See (SEE = eyes), SSB = Say (SAY = mouth)' — anti-Ro/SSA helps you SEE (eyes affected), anti-La/SSB helps you SAY (mouth affected). Or simply: SSA comes before SSB alphabetically, just like eyes come before mouth on the face from top to bottom.

Why it works

The Filipino phrase 'Dry na ang Mata at bibig' is the actual clinical description in everyday language. The SEE/SAY association with SSA/SSB creates a paired association that links antibody names to organ involvement.

Example usage

Question: 'Which antibodies are associated with Sjögren's syndrome?' → Dry Mata (SSA/SEE) and Dry bibig (SSB/SAY) → anti-Ro (SSA) and anti-La (SSB).

Recall trigger

Dry na ang Mata at bibig, Arthritis pa — SSA = SEE, SSB = SAY

Memory aid

Think of the immune system as the Philippine National Police (PNP). The CD4+ T helper cells are the POLICE CHIEFS — they coordinate all units (B cells, cytotoxic T cells, macrophages). HIV is like a NINJA who specifically targets and assassinates the police chiefs. Once too many chiefs are killed (CD4 < 200), the entire police force collapses — criminals (opportunistic infections) run free. Normal police force: 500–1,600 chiefs. AIDS: fewer than 200 chiefs — total collapse of law and order.

Why it works

The law-enforcement analogy makes the role of CD4 cells (coordinators) and the consequence of their loss (immune collapse) immediately logical. Filipino students are familiar with the PNP framework. The numbers 500, 1600, and 200 are embedded in the story.

Example usage

Question: 'At which CD4 count is a patient classified as having AIDS?' → Police chiefs below 200 → CD4 < 200 cells/mm³ = AIDS definition.

Recall trigger

HIV kills the PNP Chiefs (CD4 cells) — below 200 = total chaos

Memory aid

Pedro got exposed to HIV on a Monday. On Tuesday he went to the health center and tested NEGATIVE. He told his partner 'Wala akong HIV — negative ako!' But his nurse said: 'Pedro, you are in the WINDOW PERIOD. The virus is there but your body has not yet made enough antibodies for the test to catch it. You are like a typhoon that hasn't been detected on radar yet — it is real, it is dangerous, but the instruments cannot see it yet. Come back in 3 months and test again. In the meantime, do not assume you are negative — protect your partner.'

Why it works

The Philippine typhoon analogy is culturally powerful — Filipino students know how typhoons can exist before radar detects them. The story of Pedro's mistake corrects a common dangerous misconception and makes the concept emotionally sticky through the drama of potential partner exposure.

Example usage

Question: 'A patient tested negative for HIV 2 weeks after a needle-stick injury. What is the correct nursing interpretation?' → Typhoon not on radar yet → window period — retest at 3 months; result may be false negative.

Recall trigger

Typhoon not yet on radar — window period

Memory aid

Remember: PCP hits at the 200 CHECKPOINT. Think of a highway checkpoint — when your CD4 drops BELOW 200, you hit the PCP checkpoint and must start co-trimoxazole to pass safely. 'CO-TRI stops PCP at 200' — CO-TRImoxazole, at CD4 less than TWO-hundred, prevents PCP. Also recall: PCP presents with a DRY COUGH, DYSPNEA, and FEVER — 'Dry Cough + Fever + AIDS = PCP until proven otherwise.'

Why it works

Highway checkpoint imagery is familiar from LTFRB/traffic checkpoints in the Philippines. Linking the CD4 threshold of 200 to a 'checkpoint' makes the number memorable and contextually meaningful. The clinical presentation is summarized in one diagnostic clue.

Example usage

Question: 'An HIV-positive patient has a CD4 count of 180. Which prophylactic medication should be started?' → Hit the 200 checkpoint → co-trimoxazole for PCP prophylaxis.

Recall trigger

CD4 = 200 checkpoint → start co-trimoxazole to prevent PCP

Memory aid

Remember transmission by BSP — 'Blood, Sex, Pagsilang (birth/perinatal)' — like the Bangko Sentral ng Pilipinas, HIV transmission is strictly regulated through these THREE channels only. Nothing else. Shaking hands? Hindi kasali. Sharing utensils? Hindi kasali. Mosquito bite? Hindi kasali. BSP only — Blood, Sex, Pagsilang.

Why it works

Using BSP (Bangko Sentral ng Pilipinas) as a mnemonic is a culturally clever anchor because Filipino students know BSP as a strict regulatory body — paralleling how HIV is 'strictly' transmitted only through specific routes. The Filipino word 'Pagsilang' (birth/perinatal) makes it memorable.

Example usage

Question: 'A nurse is teaching a group about HIV transmission. Which activity does NOT transmit HIV?' → BSP only → sharing a meal together is not on the list → correct answer: sharing utensils does NOT transmit HIV.

Recall trigger

BSP — Blood, Sex, Pagsilang

Memory aid

'Seventy-two is the magic clue, start your PEP or HIV breaks through. Twenty-eight days, do not delay — finish the course and keep HIV away!' Also remember: PEP = 72 Hours, 28 Days — think of 7+2 = 9 and 2+8 = 10 (just a memory trick for the numbers). Or: 72 = THREE DAYS (3 × 24 hours). You have THREE DAYS to run to the clinic.

Why it works

Rhymes activate the brain's phonological loop, creating an auditory memory trace. The rhyme encodes both the time limit (72 hours) and duration (28 days) simultaneously. The alternative calculation (3 × 24 = 72) reinforces the number through a different pathway.

Example usage

Question: 'A nurse sustains a needle-stick injury at 8 PM on Monday. Until when should PEP be initiated?' → Seventy-two is the magic clue → within 72 hours = by 8 PM Thursday at the latest. Duration = 28 days.

Recall trigger

Seventy-two is the magic clue

Memory aid

Think of standard precautions as the 'TREAT ALL ADOBO AS POTENTIALLY SPICY' rule. In the Philippines, some adobo looks mild but is actually VERY hot. You cannot tell by looking at it. So you always have water (gloves, PPE) ready before taking a bite — for EVERY serving, not just the ones labeled 'maanghang.' Similarly, you cannot tell which patient's blood contains HIV, Hepatitis B, or Hepatitis C by looking — so every blood sample gets the same precautions. Treat ALL as potentially spicy.

Why it works

The adobo analogy is deeply Filipino and triggers immediate recognition. The 'cannot tell by looking' principle is perfectly captured by the appearance of mild-looking spicy food. The parallel to 'cannot tell which patient carries infection' is direct and logical.

Example usage

Question: 'A nurse is drawing blood from a patient with no known infectious disease. Should standard precautions still be applied?' → ALL adobo rule → YES, standard precautions apply to EVERY patient regardless of diagnosis.

Recall trigger

Treat ALL adobo as potentially spicy = treat all body fluids as infectious

Memory aid

Imagine HIV as a CRIMINAL GANG with three different entrances into a building. Using only ONE guard blocks one entrance — the gang just uses the other two doors. You need THREE GUARDS at different doors (three drugs from different classes) to trap them all. Even then, the gang does not disappear — they are TRAPPED AND SUPPRESSED, not eliminated. The goal is to make the gang SO QUIET that they cannot be detected (undetectable viral load). Stop one guard and the gang LEARNS to bypass him (drug resistance). Keep all three guards forever.

Why it works

The multi-entrance building analogy makes the rationale for combination therapy immediately logical, not just a rule to memorize. It also explains why single-drug therapy fails and why lifelong adherence is needed — both derived from the same analogy.

Example usage

Question: 'Why is monotherapy NOT used for HIV treatment?' → One guard, two open doors → virus uses other pathways → resistance develops → combination therapy required.

Recall trigger

Three guards at three different doors = 3-drug ART from 2 classes

Memory aid

Remember RA 11166 by thinking: '11166 = 1-1-1-66 = ONE HIV law, ONE confidentiality rule, ONE no-discrimination rule, and the magic number 66 → flip it → 99 → close enough to 15 (just remember FIFTEEN for consent age).' Better mnemonic: RA 11166 = 'HIV has 3 PILLARS: Confidentiality, Non-discrimination, Voluntary testing. Age 15 = the magic testing age.' Or use: 'HIV CNV-15' — C = Confidentiality, N = Non-discrimination, V = Voluntary testing, 15 = consent age.

Why it works

The CNV-15 acronym is short, pronounceable, and captures all four key provisions of RA 11166 in sequence. For NLE board exams, knowing the three pillars and the age of consent are the two most commonly tested provisions of this law.

Example usage

Question: 'Under RA 11166, what is the minimum age for voluntary HIV testing without parental consent?' → HIV CNV-15 → Age 15. Question: 'A nurse discloses a patient's HIV status to a co-worker. This violates which provision of RA 11166?' → C of CNV → Confidentiality.

Recall trigger

HIV CNV-15 → Confidentiality, Non-discrimination, Voluntary testing, Age 15

Memory aid

Think of calcineurin inhibitors as a VERY POWERFUL DIAL on a radio. Too LOW = the immune system attacks the new organ (rejection). Too HIGH = the immune system is so suppressed that infections kill the patient. The nurse's job is to keep the dial in the THERAPEUTIC WINDOW — not too soft, not too loud. Drug levels are the volume meter. Grapefruit juice JAMS the dial upward (raises drug levels by blocking metabolism) — so it is forbidden. Live vaccines are like INVITING THE ENEMY IN when all the guards are asleep — never allowed when immunosuppressed.

Why it works

The radio dial analogy makes the concept of therapeutic window instantly understandable. The grapefruit-as-jam (jammer) and live-vaccine-as-inviting-enemy metaphors directly encode both the mechanism and the clinical action required.

Example usage

Question: 'A post-renal transplant patient asks if he can drink grapefruit juice. What is the nurse's response?' → Grapefruit jams the dial upward → AVOID grapefruit juice — it raises calcineurin inhibitor levels to toxic range.

Recall trigger

Calcineurin inhibitor = sensitive radio dial; grapefruit jams it upward; no live enemies (live vaccines)

Memory aid

Remember LUPUS NEPHRITIS monitoring with PHECH — 'Proteinuria, Hematuria, Edema, Creatinine (rising), Hypertension' — pronounced 'PETCH' like a volleyball spike. When SLE spikes (flares) into the kidneys, you PETCH these five signs. And your monitoring referee is anti-dsDNA — when it rises, the game (nephritis) is getting worse.

Why it works

The volleyball spike metaphor connects to a sport popular in Philippine schools, making it culturally relevant. PHECH covers all five key monitoring parameters and can be recalled sequentially from the acronym.

Example usage

Question: 'Which laboratory and clinical findings indicate worsening lupus nephritis?' → PETCH → Proteinuria, Hematuria, Edema, rising Creatinine, Hypertension — plus rising anti-dsDNA.

Recall trigger

SLE spikes the kidney — PETCH (PHECH) it

Memory aid

'When in doubt, wash it out — hands before and hands after, infection prevention is no laughing matter. Gloves protect but do not replace, the single most important nursing grace.' Simple rule: HAND HYGIENE = NUMERO UNO. Before and after every patient contact, before and after every procedure. If the NLE asks 'what is the MOST IMPORTANT single measure' — the answer is always HAND WASHING / HAND HYGIENE.

Why it works

The 'Numero Uno' declaration creates an absolute memory anchor — no ambiguity. For NLE questions asking for priority measures, students need a clear, unqualified fact. The rhyme reinforces it through rhythmic memory.

Example usage

Question: 'The nurse is caring for a patient with HIV infection. What is the MOST IMPORTANT single infection-control measure?' → Numero Uno → Hand hygiene before and after every patient contact.

Recall trigger

Numero Uno = Hand Hygiene

Memory aid

Visualize a VOLUME METER on a speaker. When the volume is so low it reads ZERO — you cannot hear it, you cannot spread the sound. HIV viral load at UNDETECTABLE = the speaker is OFF. The virus is still inside (not cured) but it cannot jump to another person sexually. This is the DOH and UNAIDS message: U=U. Teach patients: 'Strict ART adherence → undetectable viral load → you protect your partner.'

Why it works

The sound/volume metaphor makes an abstract virological concept (viral load below detection threshold) concrete and visual. The linkage to patient empowerment and partner protection adds emotional significance, making it memorable.

Example usage

Question: 'An HIV-positive patient on ART has had an undetectable viral load for 2 years. What does the U=U principle mean for this patient?' → Volume at zero → does not sexually transmit HIV to partners while maintaining undetectable viral load.

Recall trigger

Volume meter at ZERO = Undetectable = Untransmittable

Memory aid

Nurse Riza was in a hurry during a busy triage shift in the ERQ of a DOH hospital. She told herself, 'I will just quickly recap this needle — savers ng oras (saves time).' The cap slipped. The needle went into her thumb. Seventy-two hours later she was taking PEP. Thirty days of medications, HIV anxiety, occupational health reports, and a lifelong lesson: THERE IS NO SUCH THING AS A QUICK RECAP. ALWAYS SHARPS CONTAINER. ALWAYS IMMEDIATELY. Riza's thumb always remembers.

Why it works

The micro-story of Nurse Riza uses a relatable clinical scenario — a busy ER shift — and turns the consequence of a simple mistake into an unforgettable narrative with emotional weight. 'Riza's thumb' becomes a mental shorthand for the rule.

Example usage

Question: 'After administering an IV medication, what should the nurse do with the needle?' → Riza's thumb → NEVER recap → dispose IMMEDIATELY in puncture-proof sharps container.

Recall trigger

Riza's thumb — no quick recap ever

Answer

SLE Butterfly (Malar) Rash

Memory link

A1 — Mariposa on the face visual association

Answer

Anti-dsDNA antibody

Memory link

A2 — Strict Tita Smith mnemonic; anti-dsDNA tracks disease activity and nephritis

Answer

CD4+ T helper lymphocyte; CD4 count below 200 = AIDS

Memory link

A8 — PNP Police Chief analogy

Answer

Window Period — infected and infectious but antibody tests are negative; retest at 3 months

Memory link

A9 — Pedro and the undetected typhoon micro-story

Answer

ART combination therapy — at least 3 drugs from 2 or more classes; never monotherapy to prevent drug resistance

Memory link

A14 — Three guards at three doors micro-story

Answer

Grapefruit juice — raises calcineurin inhibitor (cyclosporine/tacrolimus) blood levels by blocking drug metabolism

Memory link

A16 — Radio dial analogy for transplant immunosuppression

Answer

RA 11166 — Philippine HIV and AIDS Policy Act of 2018; confidentiality, non-discrimination, voluntary testing, age of consent 15

Memory link

A15 — HIV CNV-15 mnemonic

Answer

Recapping a used needle — should always dispose directly into a puncture-proof sharps container without recapping

Memory link

A20 — Nurse Riza micro-story

Mnemonic

'200 OR OPPORTUNISTIC = AIDS' — Remember: 'Below 200 or Bad Bug = AIDS.' The number 200 is your CUTOFF LINE. Cross it or get an AIDS-defining condition = clinical AIDS.

When to use

Use when classifying HIV disease stage, determining ART urgency, starting OI prophylaxis, or answering NLE questions about AIDS diagnosis criteria.

What each part means

CD4 < 200 = quantitative criterion (immune collapse measured by lab); AIDS-defining OI or malignancy = clinical criterion (proof the immune system has failed regardless of CD4 count). Either one alone is sufficient to diagnose AIDS.

Mnemonic

'72-28 Rule' — Think: 7+2=9 (for 72 hours) and 2+8=10 (for 28 days). Or simply: '3 days to START, 4 weeks to FINISH.' Three days = 72 hours. Four weeks = 28 days.

When to use

Use when a healthcare worker sustains a needlestick injury, a patient reports sexual assault, or there is any occupational/non-occupational HIV exposure.

What each part means

72 hours = maximum window to initiate PEP for effectiveness; starting later significantly reduces efficacy. 28 days = full course needed to suppress viral replication and prevent infection establishment.

Mnemonic

'200 is PCP's favorite number' — When CD4 falls BELOW 200, PCP moves in. Start co-trimoxazole at exactly the same threshold used to diagnose AIDS. '200 = AIDS gate AND PCP door.'

When to use

Use when determining the appropriate time to initiate OI prophylaxis in HIV-positive patients. Also helps recall that PCP is an AIDS-defining condition by definition (occurs at CD4 < 200 = AIDS).

What each part means

CD4 < 200 = the immune threshold below which Pneumocystis jirovecii can cause pneumonia. Co-trimoxazole (TMP-SMX) prophylaxis prevents PCP. Same number as the AIDS diagnostic threshold — both are 200.

Recall test

Without looking: Name 4 antibodies/labs in SLE diagnostics and their clinical significance. Which one tracks nephritis activity? Which one is most specific? What happens to complement during a flare?

Memory chain

Think of a CASTING CALL for an SLE movie. ANA is the CASTING AGENT who auditions EVERYONE (sensitive — sees all). Anti-dsDNA is the LEAD ACTOR who only works in SLE films AND reports on set activity (tracks disease). Anti-Smith is the DIRECTOR'S STAMP — rare, only for SLE, but does not tell you how filming is going. Complements C3 and C4 are the PRODUCTION BUDGET — when the movie (disease) is active, the budget gets spent (complement levels fall).

Items to remember

• ANA — sensitive, not specific (positive in almost all SLE)
• Anti-dsDNA — specific for SLE, tracks disease activity and nephritis
• Anti-Smith (anti-Sm) — most specific for SLE, does not track activity
• Complement C3 and C4 — DECREASE during active SLE (consumed by immune complexes)

Recall test

Without looking: At what CD4 level do you start co-trimoxazole prophylaxis? At what level is AIDS defined? What is the treatment goal for viral load? What OIs occur at CD4 below 100?

Memory chain

Imagine a TRAFFIC LIGHT SYSTEM with CD4 as the fuel gauge: GREEN ZONE (500–1,600) = full tank, all systems go. YELLOW ZONE (below 500) = warning light, start ART. RED ZONE (below 200) = STOP — AIDS, start co-trimoxazole. CRITICAL ZONE (below 100) = engine failure — CMV, Crypto, MAC attacking. GOAL = EMPTY GAUGE FOR THE VIRUS (undetectable viral load = U=U).

Items to remember

• CD4 500–1,600 = Normal immune function
• CD4 < 500 = Early HIV — symptomatic, start ART
• CD4 < 200 = AIDS threshold — start co-trimoxazole for PCP prophylaxis
• CD4 < 100 = High-risk for CMV retinitis, cryptococcal meningitis, MAC
• Viral load UNDETECTABLE = Treatment goal (U=U)

Recall test

Without looking: Name the 5 ART drug classes and their mechanism. Which class is now preferred for first-line therapy? Which class blocks integration? Name one drug from each class.

Memory chain

Picture the HIV replication cycle as a CRIMINAL'S PLAN to break into a house: ENTRY INHIBITORS block the criminal at the FRONT GATE. NRTI and NNRTI block the criminal from MAKING A KEY (reverse transcription). INTEGRASE INHIBITORS stop the criminal from HIDING HIS PLANS INSIDE (integration into host DNA). PROTEASE INHIBITORS stop the criminal from ASSEMBLING HIS WEAPONS before he leaves (protein processing). Each class stops a different step — that is why combination beats monotherapy.

Items to remember

• NRTIs — block reverse transcriptase using fake nucleosides (tenofovir, lamivudine, zidovudine)
• NNRTIs — block reverse transcriptase directly (efavirenz, nevirapine)
• Integrase inhibitors — block integration of viral DNA into host cell (dolutegravir, raltegravir) — NOW PREFERRED first-line
• Protease inhibitors — block viral protein maturation (lopinavir/ritonavir)
• Entry/Fusion inhibitors — block HIV entry into cell (enfuvirtide, maraviroc)

Recall test

Without looking: List the five priority elements of standard precautions in sequence. What is the SINGLE most important measure? What do you do IMMEDIATELY after a needlestick? Within how many hours must PEP start?

Memory chain

Use the phrase: 'HANDS — GEAR — NO CAP — REPORT — ALL ARE SUSPECTS.' Hands first. Gear up (PPE). No cap on needles. Report every stick. All body fluids are suspects. This five-step chain covers the complete standard precautions protocol from first action to the overarching principle.

Items to remember

• Hand hygiene — ALWAYS first and last, most important single measure
• PPE selection — gloves for all blood/body fluid contact; add gown/mask/eye protection if splash risk
• Never recap needles — immediate sharps container disposal
• Needlestick response — wash site immediately, report, evaluate for PEP within 72 hours
• Treat ALL patients' blood/body fluids as infectious regardless of diagnosis

Recall test

Without looking: Name all 5 components of CREST syndrome. Which one is typically the EARLIEST sign? What is the leading cause of DEATH in scleroderma (not part of CREST but connected)?

Memory chain

You are hiking the MOUNTAIN CREST in Benguet. It is cold (RAYNAUD). Your skin is tight (SCLERODACTYLY). You see red dots on your hands in the sunlight (TELANGIECTASIA). You feel hard lumps under your skin (CALCINOSIS). You cannot swallow your trail snack (ESOPHAGEAL dysmotility). From peak to base: Cold fingers, tight skin, red spots, hard lumps, can't swallow — CREST on the mountain.

Items to remember

• C — Calcinosis (calcium deposits under skin)
• R — Raynaud phenomenon (fingers: white → blue → red with cold/stress)
• E — Esophageal dysmotility (dysphagia, GERD)
• S — Sclerodactyly (tight skin of fingers)
• T — Telangiectasia (small red vascular lesions on skin/mucous membranes)