Mehl. TORCHeS: rubella and CMV Flashcards
CMV. Congenital cytomegalovirus is a diagnosis of exclusion on NBME Qs, as per my observation.
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CMV. CP? 4
Congenital deafness, hepatomegaly, “blueberry muffin rash,” and intracranial calcifications are HY, but these are non-specific and seen in other conditions too.
CMV.
The USMLE Q might say, “Kid is born with intracranial calcifications, hepatomegaly, and deafness.” And the student says, “Aren’t calcifications toxo?” Yes, but toxo is the strict triad as mentioned above. The student might also say, “Well can’t deafness be rubella or
syphilis.” Yes, but for rubella they always mention PDA, and for syphilis they alwaysmention unique findings like tooth or shin abnormalities (discussed below). So we eliminate to get there and are left with CMV. It’s a bit circuitous, but it’s what I’ve observed they do with CMV Qs.
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CMV. causes appearance of what cells?
CMV causes owl-eye appearance of cells due to intranuclear inclusions.
CMV. Tx?
Ganciclovir. MOA is DNA polymerase inhibitor. Mechanism of resistance is alterations to viral thymidine kinase.
Rubella. pass-level HY fact-CP???
patent ductus arteriosus (PDA) in a neonate.
Rubella. other CP?
Cataracts and deafness also possible.
Rubella.
Q doesn’t need to say mom had rash while pregnant. Sometimes pregnant women get only arthritis. This is not unique to rubella, but I’m just mentioning it because the stem can say she had arthritis but no rash, and student is like “Well it couldn’t have been rubella in the mom then.” No. Adults sometimes get only arthritis if they contract rubella or measles.
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Rubella.
MMR vaccine is live-attenuated and is……. pregnancy
Is contraindicated during pregnancy due to
theoretical risk to the fetus.
Rubella.
If a woman inadvertently receives the vaccine while
pregnant or within the month prior to pregnancy, it is not an indication for abortion, but risks to the fetus are increased and proper monitoring is important.
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