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Medical Studies 1 > 8.1 Pathophysiology of SARS-CoV-2 > Flashcards

8.1 Pathophysiology of SARS-CoV-2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Which receptor does COVID-19 use to attach to host cells?

A

ACE 2

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2
Q

Which receptor does COVID-19 use to fuse with the host cell?

A

TMPRSS2

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3
Q

How can people have asymptomatic/mild cases of COVID-19

A
  • Early innate immune response
  • Detection of PAMPs through PRRs
  • Rapid response controls infection
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4
Q

The lungs only have a medium density of ACE2 relative to other tissues in the body; why is the infection mostly in the lungs?

A
  • Because the mode of infection of the virus is respiratory
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5
Q

ACE vs ACE2

A

ACE: Turns Ang I to Ang II
ACE2: Hydrolyses Ang I, not making Ang II

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6
Q

What is the role of ACE2 in the lung?

A

To protect the lung from Ang II induced inflammation

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7
Q

What is PANoptosis?

A

Inflammatory cell death pathway

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8
Q

List two ways in which PANoptosis can damage tissue

A
  • Damages structure of tissue
  • Leads to release of DAMPs and inflammatory cytokines from dying cells, possibly triggering cytokine storms
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9
Q

What is a cytokine storm?

A

A life-threatening condition caused by inflammatory programmed cell death

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10
Q

Which cytokines trigger PANoptosome formation?

A
  • TNF
  • IFN gamma
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11
Q

Describe the positive feedback loop of a cytokine storm

A
  • Infection
  • Release of cytokines
  • Recruitment of cells
  • New cells released cytokines (including TNF and IFN gamma)
  • PANoptosome fomation
  • PANoptosis (more cell death)
  • PANoptosis causes further cytokine release (uh oh…)
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12
Q

Severe outcomes of cytokine storm

A

Systemic inflammation and organ failure

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13
Q

What happens to the alveoli during COVID-induced ARDS?

A
  • Increased fluid in alveoli
  • Surfactant breakdown
  • Decreased efficiency of gas exchange
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14
Q

ARDS symptoms/signs

A
  • Dyspnoea
  • Low O2 sat
  • Tahchypnoea
  • Rattling sounds when breathing
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15
Q

What happens to ACE2 levels as you age?

A

It decreases

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16
Q

How can COVID-19 infect multiple organs?

A

Because the ACE2 inhibitors are expressed in many organs of the lung, often in higher density than the lungs

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17
Q

Risk factors for severe illness in COVID-19

A
  • Age
  • Smoking
  • Pregnancy
  • Male gender
  • Chemotherapy
  • Childhood cancer
  • Diabetes
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18
Q

Symptoms of cytokine storm

A
  • Fever
  • Nausea/vomiting
  • Confusion
  • Chills
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19
Q

Is COVID-19 enveloped or non-enveloped? What does this mean?

A
  • It is enveloped
  • This means it has a protein capsid surrounding its RNA
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20
Q

List some organs with high levels of ACE2

A
  • Small intestine
  • Testis
  • Kidneys
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21
Q

List some organs with medium levels of ACE2

A
  • Lungs
  • Liver
  • Bladder
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22
Q

List some organs with low levels of ACE2

A
  • Blood
  • Brain
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23
Q

Main mechanism of transmission of SARS-CoV2

A

Close-contact droplet infection

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24
Q

Primary target cells for SARS-CoV2

A

Epithelium is respiratory and intestinal tract

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25
Q

Why is COVID-19 prone to mutation?

A

RNA Dependent RNA Polymerase does not have a proofreading mechanism

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26
Q

Variant of interest vs variant of concern

A

Interest: consistent thorughout community/within clusters
Concern: Increased transmissibility, virulence, or decreased effectiveness of treatment

27
Q

Order of dominance of COVID variants

A
  • Alpha
  • Beta
  • Gamma
  • Delta
  • Omicron
28
Q

Change in case numbers and mortality of COVID over time

A
  • Case numbers going up
  • Mortality going down
29
Q

Define endemic

A

Health conditions that occurs at a predictable rate in a particular region

30
Q

Define outbreak

A

Unpredicted increase in the number of people presenting a health condition of the occurrence of cases in a new area

31
Q

Define epidemic

A

Outbreak that spreads to larger geographic areas

32
Q

Define pandemic

A

Epidemic that’s spread over multiple countries or continents

33
Q

Early infection COVID symptoms

A
  • Cold like symptoms
  • Smell/taste disorders
  • Lymphopaenia
34
Q

Pulmonary phase (Stage 2) COVID symptoms

A
  • Respiratory distress
  • Coughing/phlegm
  • Dyspnoea +/- hypoxia
35
Q

Hyperinflammation phase COVID symptoms

A
  • ARDS
  • Shock
  • Cardiac failure
36
Q

Breathing support for COVID (with increasing severity)

A

Nothing -> Oxygen -> More O2/BiPAP -> ventilation

37
Q

Describe the symptoms of COVID-related Kawasaki disease

A
  • Inflammation of blood vessels, particularly in eyes, palms, soles of feet, tongue
38
Q

List preventative measures for COVID-19

A
  • Vaccination
  • Masks
  • Social distancing
  • Isolation/quarantine
39
Q

How does an increased number of comorbidities change an individual’s chance of death from COVID?

A

It increases it

40
Q

What two medications are used during stage 1 of COVID-19 (viral replication; mild symptoms)?

A
  • Antivirals
  • Anti-spike monoclonal antibodies
41
Q

What two medications are used during stage 2 of COVID-19 (pulmonary phase)?

A
  • Antivirals (remdesivir)
  • Corticosteroid (dexamethasone)
42
Q

What two medications are given during stage 3 of COVID-19 (hyperinflammation phase)?

A
  • Corticosteroid (dexamethasone)
  • Anti-Il 6 mAbs, JAK inhibitors
43
Q

How do monoclonal antibodies limit the virulence of COVID-19?

A

Bind to spike protein

44
Q

For whom are monoclonal antibodies indicated in COVID-19?

A
  • Unvaccinated
  • Immunocompromised
45
Q

How can oral antivirals reduce viral replication through amino acid insertion

A

Insert foreign amino acid into genetic material of virus, nullifying genetic code and preventing replication

46
Q

How does remdesivir (IV antiviral) inhibit viral replication

A

Inhibits activity of RdRp

47
Q

Broadly, how do JAK inhibitors work?

A
  • Prevent activation of signal transducers
  • Prevents release of cytokines
48
Q

Which patients should be considered for long-acting antibody combination against covid-19?

A
  • Immunocompromised
  • Allergy; cannot be vaccinated
49
Q

Risk factors for severe disease in COVID-19

A
  • Age > 55
  • Obesity
  • Pregnancy
  • CKD
  • Immunosuppressive disease
  • CVD
  • Diabetes
50
Q

In what % of COVID-19 patients does ARDS occur?

A

5%

51
Q

What % of patients require ventilation with COVID-19?

A

20-100%

52
Q

List some complications of COVID-19

A
  • ARDS
  • Persistent fever
  • Dehydration
  • Hypovolaemia
53
Q

Cardiac complications of COVID-19

A
  • MI
  • Arrhythmia
  • Cardiac arrest
54
Q

Neurological complications of COVID-19

A
  • Delirium
  • Nerve inflammation/paarlysis
  • Stroke
55
Q

Liver and GI complications of COVID-19

A
  • Liver dysfunction
  • Mesenteric ischaemia
56
Q

Steroids can be used in treatment of COVID-19. Provide some complications that can arise from this

A
  • Stress ulcers
  • Hyperglycaemia
  • Fungal pneumonia
57
Q

How do steroids increase risk of fungal infection

A

Delay epithelial regeneration

58
Q

Is long COVID more common in older or younger people?

A

Older

59
Q

Risk factors for long COVID

A
  • Women
  • Increasing age
  • Diabetes
60
Q

Is there any correlation between disease severity and long COVID occurrence?

A

No

61
Q

Complications of long COVID

A
  • Organ damage
  • Altered immune status
62
Q

List a bunch of possible symptoms of long covid

A
  • Fatigue
  • Muscular weakness
  • Joint pain
  • Dyspnoea
  • Cough
  • Headaches
  • Palpitations
63
Q
A

Medical Studies 1 (90 decks)

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