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Repro Images + Micro > HPV > Flashcards

HPV Flashcards

1
Q

Tropism of HPV

A

Epithelial cells of skin and mucosa

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2
Q

How does HPV recurrence occur?

A

HPV genome remains in basal layer of the skin in non-permissive cells (epithelial cells)

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3
Q

Despite most people becoming infected with an HPV genotype early in life, most of these infections don’t manifest as warts because:

A

Innate immunity keeps them in check

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4
Q

Low risk

A

6&11

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5
Q

High risk

A

16, 18, 31, 33

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6
Q

SPI

A

Sub-clinical papilloma infection; most likely HPV 16 or 18 pr 31 = HIGH RISK!!

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7
Q

Vaccine protein

A

L1 caspid protein

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8
Q

Required for development of cervical cancer over time

A

HPV 16 or 18

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9
Q

Capsid proteins

A

L1 and L2; self-assemble into caspid

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10
Q

Provides stability of HPV

A

Non-enveloped

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11
Q

Where does replication of HPV occur?

A

Permissive cells, like keratinocytes

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12
Q

What does HPV do in non-permissive cells?

A

Transforms them and incorporates part of their genome (always includes E6 and E7)

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13
Q

HPV genome in benign vs. malignant cells

A

Maintained extra-chromosomally in benign cells but part of genome is in malignant cells (always includes E6 and E7)

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14
Q

5 features of transformed (non-permissive) cells

A
  1. No longer contact inhibited
  2. No longer anchorage-dependent
  3. Don’t require growth factors
  4. Immortal
  5. Tumor formation
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15
Q

Function of early genes

A

Replication and assembly

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16
Q

Function of late genes

A

Structure, i.e. caspid proteins

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17
Q

E6 function

A

Degrades p53

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18
Q

E7 function

A

Inactivates Rb

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19
Q

E6 and E7 expression in transformed cells is (higher, lower) because:

A

Higher

Loss of E2

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20
Q

Genes that are always incorporated into transformed cell genome:

A

E6 and E7

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21
Q

Cells initially infected by HPV

A

Germinal cells of basal skin layer

22
Q

Describe pathogenesis of a wart

A
  1. HPV infects germinal cells
  2. Germinal cells and non-permissive so they become transformed
  3. Germinal cells differentiate into keratinocytes and become permissive
  4. Virus replication and shedding
  5. Benign tumor (wart)
23
Q

Why do warts tend to cluster?

A

Keratinocytes shed virus, which infects surrounding basal layer cells

24
Q

Caused by HPV 6 & 11

A

Anogenital warts (condyloma acuminatum/plana) and infantile laryngeal papillomas

25
Q

Caused by HPV 16, 18, and 31

A

Cervical, anal, neck, penile, oral CA

SPI

26
Q

Presents before age 5

A

Infantile laryngeal papillomas

27
Q

A patient has a history of warts at age 2, 6, 13, and 15. What may be going on?

A

Epidermodysplasia verruciformis - inherited defect of cellular immunity so HPV can’t be cleared

28
Q

Respiratory distress

A

Infantile laryngeal papillomas - up to 3% mortality per year

29
Q

Most warts are (benign, malignant) and (persist for life, disappear if untreated)

A

Benign

Disappear within 2 years if untreated

30
Q

Hands or face of children

A

Verruca plana, verruca vulgaris

31
Q

Colposcopy

A

Brush infected area with vinegar –> if cells turns white = wart or dysplasia = SPI

32
Q

Koilocytes

A

Squamous epithelial cells with vacuolated cytoplasm caused by HPV

33
Q

What percent of cervical dysplasia is caused by HPV?

A

90%

but most will not become metastatic

34
Q

Manifestation of epidermodysplasia verruciformis

A

Multiple warts on face, trunk, and limbs beginning in early childhood; flat or macular, macular leading to nonmalignant tumors

35
Q

Usual age of pt with common wart

A

Child or young adult

36
Q

Usual age of pt with anogenital wart

A

<25 yo

37
Q

Rate of transmission of HPV to sexual partner? How many manifest with warts?

A

2/3

Most do not get warts because of effective immune response

38
Q

HPV 16 and 18 cause ___% of cervical cancer

A

70%

39
Q

Co-factors for HPV infection

A

Smoking and co-infection with HSV

40
Q

Is infantile laryngeal papilloma genetic?

A

No; up to 50% transmitted at birth from mom with genital warts

41
Q

Appearance of HPV in culture

A

Can’t be cultured!!

42
Q

3 ways to diagnose HPV

A
  1. Clinical appearance
  2. Colpo if pap abnormal
  3. HPV DNA detection in cells
43
Q

Gardasil coverage

A

6, 11, 16, 18

so condylomas and 70% of cervical cancers

44
Q

Recommended to receive Gardasil

A

All patients 9-26yo

45
Q

How effective is Gardasil?

A

Nearly 100%

46
Q

When to try a different treatment for HPV?

A

If three treatments don’t produce a result

47
Q

Name two conditions under which HPV is likely to recur.

A

Immunosuppression

Pregnancy

48
Q

How does BCA/TCA treat warts?

A

Chemically denatures HPV proteins

49
Q

What is a LEEP?

A

Tortuous procedure to remove dysplastic cells from cervix

50
Q

How does imiquimod treat warts?

A

Stimulates IF and cytokine production

51
Q

How does podofilox treat warts?

A

Anti-mitotic agent so virus can’t replicate

52
Q

HPV treatments not recommended during pregnancy

A

Podofilox, imiquimod

Repro Images + Micro (16 decks)

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