Infectious SARS-COV

Question 1

4 genera of COV

Answer 1

alpha - bats and rodents
beta - bats and rodents sars cov2
delta - birds
gamma -birds

Question 2

SARS-COV came from

Answer 2

Himalayan palm civet

Question 3

MERS COV came from

Answer 3

Dromedary camel

Question 4

SARS COV2

Disease

Answer 4

Transmitted from horse-shoe bat > civet cat > human

COVID19

Question 5

SARSCOV2 transmission

Answer 5

Human to human transmission through respiratory droplet
Virus in urine/saliva
Fecal sample anal swab
Fomites

Question 6

Which specimen will hield highest RT PCR positivity among COVID19?

Answer 6

Bronchoalveolar lavage

Not nasal, nasopharyngeal nor oropharyngeal

Question 7

RT PCR +

Answer 7

Broncheoalveolar lavage 93%
Sputum 72%
Nasal swab 93%

Question 8

SarsCOV2 proteins used by RT PCR

Answer 8

Envelope
Nucleocaspid
Spike protein - corona
RdRp - RNA dependent RNA polymerase
ORF1 gene

Question 9

Cyto threshold required to produce immunofluorescence in RT PCR

Answer 9

40 cut off

The lower the ct, the higher the viral RNA load

Question 10

A ct value less than 40 is

Answer 10

RT PCR +

Question 11

Clinical signs and symptoms of COVID19

Answer 11

Fever
DRY Cough
SOB
Muscle ache
Confusion
Headache
Sore throat
Rhinorrhea

Question 12

Unique symptom which is a predictor of covid positivity

Answer 12

Anosmia

Question 13

Mild classification of COVID

Answer 13

No signs of pneumonia

Question 14

Moderate classification

Answer 14

Signs of non-severe pneumonia (fever, dyspnea, cough)

RR <30/minute, SpO2 >92% on RA

Question 15

Mild classif mx

Answer 15

Home isolation for 14d

If elderly, admit if with unstable/uncontrolled comorb conditions

Give sx tx and supportive care
Empiric antibiotic not needed

Question 16

Moderate mx

Answer 16

Admit to COVID19
Chest xray
RT PCR

Question 17

Severe classification

Answer 17

Severe pneumonia
Fever, cough, dyspnea
RR >30
Severe respi distresscor SPO2 less than 92

Question 18

Critical phase

Answer 18

In sepsis or shock
Started severe within 1 week now worsening with progressive infiltrate in xray or CT
Respi failure not explained by cardiac failure of fluid overload

Question 19

Dose of dexamethasone given as adjunct for covid 19 patients requiring O2 on mechanical ventilation

Answer 19

6 mg IV x 10 days

Question 20

Tocilizumab adverse effect

Answer 20

Dyslipidemia for 3 years
Baseline total cholesterol, TAG, LDL are elevated predisposing to pancreatitis

Others
Hepatotoxicity
GI distress
Myelosupression - agranulocytopenia 
Pancreatitis
Reactive TB and Hep 
Anaphylaxis

Question 21

Combination of Hydroxychloroquine with Azithromycin (Macrolide) induces

Answer 21

Prolonged QT interval

Fata arrhythmia

Question 22

Recombinant humanized anti-human IL-6 receptor monoclonal antibody

Binds sIL-6R and mIL-6R and inhibits signal transduction

Currently used mainly for rheumatoid arthritis

Answer 22

Tocilizumab

Recommended for compassionate use and clinical trial