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Virology 2 > Past Papers > Flashcards

Past Papers Flashcards

1
Q

Picture of influenza virus

What will it look like?

A

spherical - can have filamentous shape

lipid envelope

spikes - haemagglutinin and neuraminidase

segmented genome

80-120nm

check electron microscopy images - can look a bit like coronavirus with envelope and spikes

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2
Q

What are 4 recently circulating types of influenza?

A

Unclear answer

Influenza A (H1N1)pdm09

Influenza A (H3N2)

Influenza B/ Yamagata

Influenza B/ Victoria

Influenza A (H5N1) - Avian influenza may be circulating in wildlife. May be an appropriate answer

Influenza C detected less frequently, and usually does not cause public health issues as mild symptoms

Influenza D only infects cattle

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3
Q

Influenza treatment

What is first line drug mechanism of action?

A

Oseltamivir

unless known to be resistant e.g H1N1

neuraminidase inhibitor - prevents cleavage of siliac acid at cell surface, preventing virions from leaving surface

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4
Q

What vaccines are available for influenza?

A

Live intranasal

Inactivated IM
- adjuvant quadrivalent vaccine (aQIV)
- recombinant quadrivalent vaccine (QIVr)
- Cell-based quadrivalent vaccine (QIVc)
- egg-grown quadrivalent vaccine (QIVe)

vaccine response takes 2-4 weeks to fully develop

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5
Q

Who is eligible for influenza vaccine?

A

Live intranasal
- children aged 2-16

Inactivated IM
- >65 years old
- pregnant
- immunocompromised patients of any age, including children who can’t have live intranasal
- occupational - healthcare workers

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6
Q

Inactivated influenza vaccine types

When is each used?

  • adjuvant quadrivalent vaccine (aQIV)
  • recombinant quadrivalent vaccine (QIVr)
  • Cell-based quadrivalent vaccine (QIVc)
  • egg-grown quadrivalent vaccine (QIVe)
A

2-18 years old
- Live attenuated vaccine
- Cell-based quadrivalent vaccine (QIVc) - if LAIV contra-indicated

18-64 years old
- recombinant quadrivalent vaccine (QIVr)
- Cell-based quadrivalent vaccine (QIVc)
- egg-grown quadrivalent vaccine (QIVe)

> 65 years old
- adjuvant quadrivalent vaccine (aQIV)
- recombinant quadrivalent vaccine (QIVr)
- Cell-based quadrivalent vaccine (QIVc) - only when every attempt to use the above two has been exhausted

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7
Q

Which influenza strains are included in vaccines 2023?

A

Influenza A H1N1
Influenza A H3N2
Influenza B Victoria
Influenza B Yamagata

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8
Q

Which groups of people cannot have LAIV?

A

immunocompromised

LAIV contains porcine gelatine - refusal to have on personal grounds

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9
Q

Patient with egg allergy

Which vaccine should be given?

Inactivated
Live

A

Inactivated vaccines are egg free/ low albumin content - safe to give

  • recombinant quadrivalent vaccine (QIVr)
  • Cell-based quadrivalent vaccine (QIVc)
  • adjuvant quadrivalent vaccine (aQIV)
  • egg-grown quadrivalent vaccine (QIVe) - do not give

LAIV
- safe for use in children with allergy mild/mod
- if anaphylaxis - only give if in hospital. Intranasal administration is less likely to have a systemic reaction than systemic

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10
Q

What are the ingredients for PCR?

A

template DNA

nucleotides - deoxyribsonucleotide triphosphates

primers - these are short stretches of single-stranded DNA that are complementary to the 3’ ends of sense and antisense strands.

Polymerase enzyme e.g reverse transcriptase or Taq polymerase

Magnesium ions - helps with DNA polymerase

Buffer - provides suitable chemical environment for DNA polymerase activity

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11
Q

What are steps of DNA PCR?

A

Denaturation - heating 94degC causes hydrogen bond breakdown and DNA strand separation

Annealing - cooled to 50-60degC, primer binding to target DNA

Extension - DNA polymerase extends the 3′ end of each primer along the template strands using nucleotides

Amplification - repeated cycles heating from 50-94degC

Fluorescent probes e.g Sybr Green can bind to DNA, and fluorescent show real-time PCR. Does not fluoresce if not bound

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12
Q

MSM with jaundice and history of unsafe sexual practices

HBsAg pos
HBeAg pos
Anti-HBe neg

How would you report?

A

Evidence of current “e” antigen positive HBV infection

unclear if acute or chronic

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13
Q

MSM with jaundice and history of unsafe sexual practices

HBsAg pos
HBeAg pos
Anti-HBe neg

Who you you report to (agencies)?

A

HPU - if acute HBV infection

iCaSH/ GP - inform if patient consents

sexual partners

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14
Q

MSM with jaundice and history of unsafe sexual practices

HBsAg pos
HBeAg pos
Anti-HBe neg

What other tests would you ask for?

A

anti-HBc IgG
anti-HBc IgM - check if acute or not

HBV DNA

LFTs/ Coagulation
UEs - if needs tenofovir

Liver USS/ Fibroscan

Liver biopsy

HDV serology

HCV
HIV

HAV IgG - immunity screen

STI - syphilis, chlamydia, gonorrhoea

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15
Q

Returning traveller from Guinea ?VHF
you receive sample for EBV serology

What do you do with the sample?

A

Store - do not handle until VHF status known
If needs handled, use Cat 3

Contact requesting team

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16
Q

Returning traveller from Guinea

How many days after return would you worry about possibility of VHF?

A

21 days

17
Q

Returning traveller from Guinea

What symptoms would prompt you to refer sample to Cat4 facility (RIPL)

A

Fever >37.5degC

extensive bleeding/ bruising

needs exposure history - e.g country or activities e.g caves

18
Q

Returning traveller from Guinea suspected VHF

name 3 other viruses which need to be handled in Cat 4 conditions

A

Herpes B virus

Henipah virus - Hendra/ Nipah

Smallpox (Variola)

VHF -
Ebola
Marburg
Lassa
Lujo
CCHF

19
Q

Returning traveller from Guinea suspected VHF

What is most important infection to exclude?

A

malaria

20
Q

NSI

HBsAg pos source

What action would you take for recipient

  1. No previous vaccine
  2. known vaccine responder
  3. known vaccine non-responder
A
  1. No previous vaccine - give accelerated vaccine and HBIG
  2. known vaccine responder - give booster if >1 year since last dose
  3. known vaccine non-responder - give vaccine and HBIG now and in one month

important - remember second dose of HBIG

accelerated vaccine - zero, one, two and 12 months

21
Q

NSI

HBsAg unknown source

What action would you take for recipient

  1. No previous vaccine
  2. known vaccine responder
  3. known vaccine non-responder
A
  1. no previous vaccine - give accelerated vaccine (no HBIG)
  2. known vaccine responder - give booster if >1 year since last dose
  3. known vaccine non-responder - give vaccine and HBIG now and in one month
22
Q

Picture of 9 month old vocal cord with lesion

What is the lesion?

A

Respiratory papillomatosis caused by HPV

benign lesions

23
Q

9 month old with pharyngeal respiratory papillomatosis

How did this occur?

A

Probably transferred from genital warts (HPV6/11) during delivery

mother probably not vaccinated

24
Q

9 month old with pharyngeal respiratory papillomatosis

What is treatment?

A

surgical removal

intra-lesion cidofovir has some effect

recurrence is very common even despite surgical procedures

25
Q

9 month old with pharyngeal respiratory papillomatosis

how to diagnose?

A

Histology

26
Q

9 month old with pharyngeal respiratory papillomatosis

Which HPV types contribute to this?

A

HPV 6/11 cause genital warts and respiratory papillomatosis

HPV 16/18 cause cancer

27
Q

What other diseases does HPV causes?

A

Cervical cancer - HPV 16/18

Penile cancer - HPV 16/18

Oropharyngeal cancer - HPV 16/18

Genital/ Anal warts - HPV 6/11

Respiratory papillomatosis - HPV 6/11

28
Q

Who is eligible for HPV vaccine given?

A
  • girls/ boys aged 12/13

2 doses

second dose 6-12 months after first

  • also MSM have not benefited from previous girls vaccination campaign. So since 2018 MSM up to 45 have been eligible for vaccination
29
Q

What does the HPV vaccine cover?

A

Gardasil 9

Gardasil 9 protects against 9 types of HPV:
6, 11, 16, 18, 31, 33, 45, 52 and 58.

Between them, types 16 and 18 are the cause of most cervical cancers in the UK (more than 80%).

Types 31, 33, 45, 52 and 58 cause an additional 15% of cervical cancers.

Types 6 and 11 cause 90% of genital warts

30
Q

HPV vaccine

What antigens does it target?

A

sub-unit vaccine - contains virus-like particles containing L1 major capsid protein

Closely resemble the virus, but lack viral DNA

Gardasil 9 targets - HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58

98-100% effective

Virology 2 (57 decks)

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