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BL/DD USMLE and Basics > DD- COMMON VIRAL PATHOGENS > Flashcards

DD- COMMON VIRAL PATHOGENS Flashcards

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USMLE® Step 1 flashcards
1
Q

8 herpesviruses which infect humans

A

-Herpes simplex virus, type 1 and type 2 (HSV1, HSV2)

– Varicella-zoster virus (VZV)

– Cytomegalovirus (CMV)

– Epstein-Barr virus (EBV)

– Human herpesvirus 6 (HHV6)

– Human herpesvirus 7 (HHV7)

– Human herpesvirus 8 (HHV8)/KSHV

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2
Q

Herpesviridae: Following primary infection, the virus establishes a______ in the host (location depends on subfamily) and may reactivate at a later time

A

latent infection

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3
Q

Human herpesvirus 8 (HHV8)/KSHV

A

herpesviruses which infect humans

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4
Q

Herpesvirus structure

A

Enveloped
- Derived from host membrane

-Virally-encoded glycoproteins are important for binding to host cells

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5
Q

Human herpesvirus 6 (HHV6)

A

herpesviruses which infect humans

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6
Q

Herpesvirus structure- Tegument

A

Contains proteins that are fully formed and active and control viral entry, gene expression, and immune evasion

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7
Q

Epstein-Barr virus (EBV)

A

herpesviruses which infect humans

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8
Q

HSV1 and HSV2

Both viruses cause painful vesicles on the ______ at the site of inoculation

A

skin

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9
Q

Cytomegalovirus (CMV)

A

herpesviruses which infect humans

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10
Q

HSV1 is usually associated with _____ lesions

A

orofacial

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11
Q

Varicella-zoster virus (VZV)

A

herpesviruses which infect humans

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12
Q

HSV2 is usually associated with

A

genital lesions (genital herpes)

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13
Q

Herpes simplex virus, type 1 and type 2 (HSV1, HSV2)

A

herpesviruses which infect humans

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14
Q

Transmission of HSV usually occurs through close contact with a person who is shedding virus at

A

a mucosal surface

in genital/oral secretions

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15
Q

Clinical Patterns of HSV Disease

A

Most primary infections with HSV are silent

Primary HSV-1 infection usually occurs during childhood

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16
Q

Primary HSV-1 infection usually occurs during______

A

childhood

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17
Q

Gingivostomatitis

A

common infection of the mouth and gums

Most common symptomatic infection

Clinical Patterns of HSV Disease

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18
Q

Herpetic whitlow

A

a lesion (whitlow) on a finger or thumb caused by the herpes simplex virus.

Occupational hazard for doctors, dentists, nurses

Clinical Patterns of HSV Disease

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19
Q

Encephalitis

A

Inflammation of the brain, often due to infection

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20
Q

_____most common cause of encephalitis in US

A

HSV

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21
Q

Herpes keratitis

A

Inflammation/infection of the cornea, leading to pain absence of trauma

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22
Q

HSV reaches the cornea via the ophthalmic branch of the ______

A

trigeminal nerve

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23
Q

Genital Herpes

A

Lesions last 10-14 days; usually very painful

Distinct from ulcers caused by syphilis (single hard painless
ulcer) and chancroid (soft painful ulcers associated with swollen inguinal lymph nodes)

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24
Q

Neonatal HSV

A

Serious disease transmitted to a newborn

3 forms:

  • Skin, eye and mucous membrane disease (SEM)
  • CNS
  • Disseminated
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25
Q

Following primary infection, HSV enters sensory nerve
endings and travels up the axon and establishes a latent
infection in:

A

sensory ganglia (alphaherpesvirus)

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26
Q

Reactivated lesions are infectious and people often continue to shed virus for a period of time_____ the lesions are healed

A

after

27
Q

Definitive diagnosis of herpes can be obtained by:

A

– Viral culture of lesions
– Direct IFA of lesions
– PCR of lesions

28
Q

Oral antiviral therapy (______ or a related antiviral) can be used for oral or genital HSV outbreaks

A

acyclovir

29
Q

_____ is recommended for pregnant women with active

genital lesions at time of delivery

A

C-section

30
Q

Prophylactic antiviral suppressive therapy has been shown to decrease outbreaks and viral shedding so is used in some patients, particularly with ______

A

genital herpes

31
Q

Varicella-Zoster Virus

A

Varicella or chickenpox

highly contagious

32
Q

acyclovir

A

Oral antiviral therapy can be used for oral or genital HSV outbreaks

33
Q

Varicella-Zoster Virus

Transmission: highly contagious

A

– Primarily respiratory via droplet or aerosolized
secretions (coughing, sneezing)

– Contact with lesions

34
Q

Varicella

A

The classic rash consists of lesions in multiple stages of development on any one part of the body (i.e. vesicles, pustules, scabs/crusts)

35
Q

Complications of varicella

A

Pregnant women and immunocompromised patients are at high risk for morbidity and mortality

36
Q

_____ has been shown to accelerate the
resolution of chickenpox if the patient presents
within 48-72 hours of onset

A

Acyclovir

37
Q

__________vaccine is currently recommended for prevention of chickenpox

A

Live attenuated varicella

38
Q

VZV is the only herpes virus in which asymptomatic viral shedding ______-in normal hosts who experience reactivation

A

does not occur

39
Q

Herpes zoster or shingles:

occurs in 30% of individuals from

A

Varicella

40
Q

Post-herpetic neuralgia

PHN

A

complication of shingles, which is caused by the chickenpox (herpes zoster) virus

41
Q

Post-herpetic neuralgia

PHN

A

Debilitating neuropathic
pain that can last weeks to
months

42
Q

Immune response to VZV

A

-Cell mediated immunity to VZV decreases w/ age

– Incidence of shingles much higher in the elderly and
immunocompromised

– Persons with low cell mediated immunity to VZV at higher risk for VZV reactivation (shingles)

43
Q

Cell mediated immunity to VZV is an important determinant

in who is at risk for

A

shingles

44
Q

Diagnosis, Chickenpox and shingles are diagnosed

clinically or

A

– Direct IFA
– HSV and VZV PCR
– Viral culture

45
Q

For shingles, acyclovir given within ______ of onset may decrease lesions and pain

A

48-72 hours

46
Q

Cytomegalovirus

A

– Almost all are asymptomatic

Primary infection in immunocompromised persons is serious and CMV can infect most organs (CMV retinitis and colitis in HIV patients)

47
Q

Cytomegalovirus Transmission

A

A person can become infected with CMV when they

come in contact with infected body fluids

48
Q

CMV infects the ___________, resulting in a persistent infection and intermittent viral shedding

A

epithelial cells of the salivary gland or the genital tract

49
Q

Congenital CMV Syndrome

A
  • Low birth weight
  • Microcephaly
  • Hearing loss
  • Mental impairment
  • Hepatosplenomegaly
  • Skin rash (blueberry muffin spots)
  • Jaundice
  • Chorioretinitis
50
Q

Neonate viral syndromes

A

neonatal HSV, or congenital VZV and

CMV syndromes.

51
Q

Most common symptomatic primary infection that occurs with HSV-1 infection.

A

Gingivostomatitis

52
Q

condition where HSV infects the cornea of the eye

A

Herpes keratitis

can be the result of a primary infection or from reactivation

53
Q 
Low birth weight
Microcephaly
Hearing loss
Mental impairment
Hepatosplenomegaly
Skin rash (blueberry muffin spots)-due to extramedullary hematopoiesis in the skin
Jaundice
Chorioretinitis
A

Congenital CMV Syndrome

54
Q

This is an extremely serious manifestation of herpes disease.

A

Encephalitis

-can be caused by primary disease or reactivation.

55
Q

Herpes encephalitis can occur either through

blood-borne (hematogenous) spread or ___________ of the virus.

A

neuronal transmission

56
Q

Herpes infection of the brain results in a fulminant and hemorrhagic, ________.
There is a strong predilection for the temporal lobes of the brain.

A

necrotizing encephalitis

57
Q

Mortality is about 30% with treatment. HSV-1 causes most cases of childhood and adult.

HSV-2 is the more common cause of neonatal herpes, Associated with maternal genital herpes infections.

A

Encephalitis

58
Q

Gingivostomatitis is common in

A

HSV-1

59
Q

Herpes Keratitis is occasional in

A

HSV-1

60
Q

“Other” virus tests (when clinical doesn’t work)

A

Viral culture of lesions

Direct fluorescent antibody stain of lesions

PCR of lesions (most expensive)

61
Q

Chicken pox (varicella) is a highly contagious and common childhood disease, which is now preventable by vaccination. Chickenpox is primarily transmitted by the _____________ via droplet or aerosolized secretions (coughing, sneezing).

A

respiratory route

62
Q

Incubation period: It takes from ________ after exposure for someone to develop chickenpox.

A

10-21 days

63
Q

The initial lesions of_______ might be flat and rose

colored, but they quickly mature into the classic “dew drop on a rose petal” which is a vesicle on an erythematosus base

A

Chicken pox (varicella)

64
Q

Pathogenesis of Chickenpox- The virus gains entry via the respiratory tract and spreads to the regional_______.

A

lymphoid system

BL/DD USMLE and Basics (55 decks)

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