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Pathophysiology > COVID > Flashcards

COVID Flashcards

1
Q

What is SARS-COV2 and what does it stand for?

A

Severe Acute Respiratory Syndrome from the Coronavirus 2
Illness caused by the COVID-19 virus

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2
Q

What other viruses does SARS-COV2 share genetic materials with?

A

SARS from 2002-2003 and MERS from 2012 which are 80% similar to it

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3
Q

Where did COVID-19 come from?

(Etiology, 3 points)

A
  • Started in Wuhan, China - traced back to a fish/meat market
  • Believed to have come from bats - 96.2% genetic similarity to bat coronavirus
  • Underwent antigenic shift from bat to human, unknown if intermediate carrier was involved
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4
Q

What 6 components is the COVID virus made of?

A
  • Spike Protein
  • Hemagglutinin Esterase Protein
  • Envelope Bilayer
  • Nucleocapsid protein
  • RNA (single strand)
  • M-protein (membrane) and E-protein (envelope)
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5
Q

What are the current variants of concern (VOC)?

A

None

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6
Q

What are the current variants under monitoring (VUM)?

A

Anything containing the F456L spike mutation

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7
Q

What are the current variants being monitored (VBM)?

A

Omicron
Alpha
Beta
Gamma

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8
Q

What is the reproductive rate (R0)?

A

How many individuals a virus can be passed on to from 1 infected individual

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9
Q

What is the series interval (Si)?

A

The time it takes (in days) to pass on a virus to another individual

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10
Q

What are the 4 modes of transmission for COVID?

A
  1. Respiratory droplet
  2. Fomite - depends on surface
  3. Fecal-oral
  4. Vertical transmission
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11
Q

How long can COVID last on surfaces (as fomites)?

A

Copper + latex = 8 hours
Wood + glass = 5 days

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12
Q

How long can COVID respiratory droplets stay in the air?

A

Up to 3 hours

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13
Q

What percent of COVID transmission occurs through vertical transmission?

A

~3% occurs during later stages of pregnancy and in breastfeeding

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14
Q

What 4 risk factors increase risk of COVID-19 infection or mortality

A

Cardiovascular disease
Lung disease
Diabetes
Immunosuppression or cancer

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15
Q

What 3 elevated lab values would indicate increased risk of mortality?

A
  • D-dimer
  • Ferratin
  • CK-MB
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16
Q

What are the 3 phases of COVIDs disease course?

A

Stage 1 - viral response
Stage 2 - pulmonary phase
Stage 3 - hyper inflammatory phase

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17
Q

Explain the viral response of COVIDs disease course:

A

The viral response includes the incubation and infectious periods
- person shows mild symptoms
- is contagious

18
Q

Explain the pulmonary phase of COVIDs disease course:

A
  • when the adaptive immune response occurs
  • person experiences hypoxia and dyspnea
19
Q

List the events of the hyper inflammation phase in COVIDs disease course (4)

A
  1. Disseminated intravascular coagulation
  2. cytokine storm
  3. ARDS
  4. multi-system organ failure
20
Q

What are the target cells and target tissue of COVID?

A

Target cells: any cells that have an ACE2 receptor

Lungs are the main target area - alveoli have type 2 pneumocytes with ACE2 receptors

**other cells also have ACE2 receptors, which is why COVID produces a variety of symptoms

21
Q

What is the co-receptor that COVID uses?

A

Transmembrane protease serine 2 (TMPRSS2)

22
Q

Explain the cytokine storm

A

AKA Cytokine release syndrome

Whole bunch of WBC are activated through air but they then release a bunch of inflammatory cytokines which then activates more immune cells

– creates positive feedback loop

23
Q

What 4 WBC are part of the cytokine storm?

A

Macrophages
Lymphocytes
Dendritic cells
Monocytes

24
Q

What are the 4 effects of the cytokine storm?

A
  1. Act on vascular endothelium (VCAMS)
  2. Activate neutrophils
  3. Impaired coagulation
  4. Increase in chemical mediators
25
Q

Explain how cytokines act on VCAMs.

A

The cytokines interleukin-1, 6, 8 tumor necrosis factor A (TNFA)
interferon gamma increase the expression of vascular cellular adhesion molecules which pull WBC out of vascular space into lungs

26
Q

Explain the activated neutrophil step of the cytokine storm

A

Increased neutrophil activity results in increased release of reactive oxygen species (ROS) and proteases = damages surrounding cells

27
Q

Explain the effects of damaged type 1 alveolar cells as a result of increased neutrophil activity

A

Damage to type 1 alveolar cells = impaired gas exchange
Hypoxia, SOB

28
Q

Explain the effects of damaged type 2 alveolar cells as a result of increased neutrophil activity

A

Damage to type 2 alveolar cells = decreases surfactant = increases surface tension = alveolar collapse
*further impairs gas exchange

29
Q

Explain how coagulation activity is impaired due to the cytokine storm

A

Increased pro-coagulants and decreased anti-coagulants results in possible clot and pulmonary emboli

30
Q

What happens when alveolar cells are damaged? (think CNS)

A

They release chemical mediators which connect with receptors related to the vagus nerve = CNS stimulation = bronchioconstriction

31
Q

What other body systems are affected by COVID?

A

Olfactory - loss of sense of taste + smell
Heart - damaged myocardial tissue
GI tract - N+V, diarrhea, abdominal pain
Kidneys - decreased function = decreased urine production
Liver - decreased function = metabolic disorders

32
Q

What are pulmonary complications that can occur due to COVID?

A

pneumonia
pulmonary edema
pulmonary emboli
ARDS

33
Q

What occurs with the lysis of cells with ACE2 receptors?

A

Increased angiotensin 2 production = affects blood pressure
Causes: pulm HTN, increased inflammation, increased vascular permeability
= results in acute lung injury

34
Q

Explain disseminated intravascular coagulation?

A

A condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels

Increase in clothing depletes the platelets and clotting factors needed to control bleeding = increased risk of excessive bleeding

35
Q

What are two methods of diagnosing COVID?

A
  1. Nasopharyngeal swab
  2. Serology
36
Q

Explain what a nasopharyngeal swab tests for?

A

A swab of cells and mucuous test from the present of RNA, it is the gold standard for testing but only has a 70% sensitivity

37
Q

How does a serology test diagnose COVID?

A

Looks for the presence of antibodies

IgM = active infection
IgG = recovered from infection

Combined with RT-PCR, sensitivity increases to 95%

38
Q

What are the treatments for mild-moderate COVID infection?

A
  • inhaled corticosteroids
  • antiretrovirals
39
Q

What are the treatments for severe COVID infection?

A
  • dexamethasone
  • antiretrovirals
    +/- supplemental O2
40
Q

What are treatments for critically ill COVID infection?

A
  • dexamethasone
  • LMW heparin
  • high-flow O2 or mechanical ventilation
  • +/- immunosuppressants to prevent or lessen cytokine storm effects

Pathophysiology (9 decks)

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