Past Papers 2

Question 1

Electron microscopy images of three viruses

review these now

Question 2

EM of these viruses

norovirus
rotavirus
adenovirus

Which patient gets each virus?

• elderly patient
• child with diarrhoea 1 month
• child with diarrhoea 2 days

Answer 2

• elderly patient - norovirus
• child with diarrhoea 1 month - adenovirus
• child with diarrhoea 2 days - rotavirus

Question 3

Norovirus

How long does this patient need to be symptom free until they can be removed from isolation?

Answer 3

48 hours symptom free

i.e not type 5-7 stools and no vomiting

Question 4

Norovirus
Adenovirus
Rotavirus

Which one is vaccine preventable?

How is vaccine administered?

Answer 4

Rotavirus

Oral vaccine

8 weeks
12 weeks

rotavirus is most common worldwide cause of diarrhoea in children <5 years old

Question 5

Rotavirus vaccine

What type of vaccine is it?

Which antigens does it target?

Answer 5

Oral

Live attenuated

85% effective against severe rotavirus gastroenteritis in the first two years of life

antigen - viral structural protein - VP4 and 7 most common

Question 6

What is the structure of rotavirus?

Answer 6

dsRNA

6x viral structural proteins - VP

6x non-structural proteins - NSPs. Only made by cells infected with actual live virus

Non-enveloped

Icosahedralnucelocapsid

Question 7

What are rotavirus G and P types?

Answer 7

51 P types - based on VP4
36 G types - based on VP7

VP4/VP7 elicit neutralising antibody responses

only few combinations of G and P types predominate and infect humans

They are G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]

Question 8

What is common side effect of rotavirus vaccine?

Answer 8

diarrhoea

intussussception

Question 9

What disease can adenovirus cause?

Answer 9

conjunctivitis

pneumonitis

hepatitis

GI tract - diarrhoea

Question 10

CMV serology in pregnant woman

IGR with microcephaly

CMV IgG pos
CMV IgM pos

How would you interpret this result?

Answer 10

Suggestive of a recent primary CMV infection, reinfection or reactivation

need further testing to clarify

Question 11

CMV serology in pregnant woman

IGR with microcephaly

CMV IgG pos
CMV IgM pos

What further tests would you undertake?

Answer 11

CMV IgM/ IgG and avidity on booking blood sample

EBV serology and rheumatoid factor - look for cross-reacting
antibodies

FBC - lymphocytosis
ALT - transaminitis

consider amniocentesis

other infections cause of IUGR

Question 12

CMV serology in pregnant woman

IGR with microcephaly

What infections would you screen for?

Answer 12

CMV

Rubella

Toxoplasma

Zika

Question 13

CMV serology in pregnant woman

IGR with microcephaly

If amniocentesis is to be performed, when should this occur?

Answer 13

after 21 weeks gestation - foetal kidneys starting to produce urine with CMV

after 6 weeks of suspected infection date

Question 14

CMV serology in pregnant woman

IGR with microcephaly

diagnosed with recent primary CMV infection

What is risk of intrauterine infection?

Answer 14

30% in primary infection 1st trimester
70% in primary infection 3rd trimester

3% if reactivation

Question 15

CMV serology in pregnant woman

IGR with microcephaly

Apart from microcephaly and IUGR, what are 3 other things caused by congenital CMV

Answer 15

IUGR

microcephaly

intracranial calcification

sensorineural hearing loss

retinitis

hepatitis - jaundice

pneumonitis

thrombocytopenia/ anaemia

low birth weight

seizures

blueberry rash

Question 16

Temporal lobe enhancement on CT - what is the diagnosis?

Answer 16

HSV encephalitis - temporal lobe enhancement is normally pathognomonic

Question 17

Temporal lobe enhancement on CT

How do you confirm the diagnosis?

Answer 17

Clinically

Lumber puncture - viral PCR, cell count

Question 18

Temporal lobe enhancement on CT

what is treatment?

Answer 18

IV aciclovir

10mg/kg TDS normal renal function

14 days - repeat LP before stopping
if still positive, then continue another 7 days before repeating LP

Question 19

HAV/HBV/HCV/HDV/HEV

What is route of transmission

Answer 19

Faecal-oral - HAV/ HEV

Blood borne - HBV/HCV/ HDV

Question 20

Name two drugs for HBV treatment

Answer 20

Tenofovir
Entecavir
Lamivudine
Adefovir
Interferon

Question 21

Name two drugs for HCV treatment

Answer 21

NS3/4A protease inhibitor
Grazoprevir
Voxilaprevir

NS5A inhibitor
Elbasavir
Ledipasavir
Velpatasvir

NS5B
Sofosbuvir

Question 22

Viva

Patient has platelets following Haemopoetic stem cell transplant

Develops hepatitis, and found to be positive for HEV

What action would you take?

Answer 22

Blood is screened for HEV RNA, so this should not happen

Patient
- high risk of acute liver failure/ chronicity
- cannot reduce immunosuppression
- consider chronic at 3 months
- consider starting ribavirin early - risk with blood counts particularly anaemia
- check pre-transplant screening bloods to ensure he did not have infection prior to transplant

Blood product
- identify contaminated sample and test for HEV
- issue may be limit of detection is too low, so low level viraemias are not detected
- issue may be pooled blood screening v individual screening
- screen other patients who are potentially infected
- complete safety alert blood products

Question 23

Viva

Surgeon presents with maculopapular rash

What diagnoses to consider?

Answer 23

This question is a bit vague

Breakthrough Measles infection

Presumably surgeon has MMR history screened by OH

Need to assess immunity of contacts, and offer HNIG/ vaccine

HIV seroconversion
Measles
Rubella
MPox early rash
Enterovirus
EBV
CMV

GAS
Staph aureus

Question 24

Surgeon with maculopapular rash

Subsequently found out to be Measles

What PEP is required for contacts?

Answer 24

First check who is susceptible - history of MMR/ immunosuppression

Immunocompetent -
MMR vaccine

Immunosuppressed -
Check Measles IgG - if neg then give HNIG

Question 25

Viva

Loss of vision in a wildlife photographer

What are diagnoses to consider?

Answer 25

Unclear question

HIV with VZV is answer

Ask about rash

Ensure all patients with a serious infection are screened for HIV