TA study Flashcards by Anna Cushing

What is mnemonic for DNA viruses HHAPPPPy?

Hepadna [HBV]
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma

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Which is the only DNA virus that is not double stranded?

parvovirus is single stranded

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What is the exception to the rule that all DNA viruses replicate in nucleus and have isocahedral shaped capsule?

poxvirus

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Which DNA viruses are nonenveloped [mnemonic]?

NAKED for PAPP smear = parvo, adeno, papilloma, polyoma

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What is the only type of virus that buds out of nuclear membrane [as opposed to golgi or plasma]?

herpesviruses

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What is a tzack smear? which herpes viruses will have it?

Tzanck smear = look for multinucleated giant cells with intranuclear inclusion bodies
sign of herpes that causes vesicles –>
HSV1, HSV2, VZV, CMV

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What is drug of choice for HSV1/2?

acyclovir

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Where is HSV1 latent? HSV2?

HSV1 in CN V ganglion

HSV2 in sacral ganglion

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What is transmission HSV1 vs HSV2?

HSV1 = respiratory secretions/saliva, oral disease
HSV2 = sexual, perinatal, genital lesions

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What is the cellular receptor that HSV1/2 binds to on host cells?

heparan sulfate

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What are major causes of viral encephalitis [mnemonic]?

HEMP AIR

herpes
encephalitis [WEE, EEE, etc]
mumps and measles
polio and other enteroviruses
adenovirus
influenza
rabies

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What is mostly likely cause of encephalitis? signs?

HSV-1

- seizures, personality change, temporal lobe destruction

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Where is VZV latent?

dorsal root ganglion [DRG]

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how is varicella vs zoster spread?

varicella by respiratory droplets/aerosols or contact

zoster = just by contact

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What is host cell receptor for EBV?

CD21 receptor on B cells, MHC Class II co receptor

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What virus associated with owl eyes?

CMV!!

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What should you think: kid with maculopapular rash, blue-white spots in buccal mucosa?

measles –> blue white spots = koplik’s spots

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What should you think: 16 yo with stiff neck, cheeks swollen? other complications of this disease?

think mumps –> asceptic meningitis, parotitis, orchitis

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What should you think: patent ductus arteriosus, purpura blueberry muffin rash, impaired hearing and vision?

congenital rubella infected mom in first trimester

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What should you thin: fever followed by descending rash?

rubella

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What should you think: descending rash with cough, coryza, conjuntivitis, kopliks spots?

measles

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What are the 4 Cs of measles?

cough
coryza
conjunctivitis
kopliks spots = blue/white spots in mucosa

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What should you think: 8 yo, high fever, sore throat, 7 vesicular lesions on soft palate?

herpangina caused by coxsackie A

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What causes hand foot and mouth disease?

coxsackie A

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Which two RNA viruses replicate in nucleus?

Influenza, HIV

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What is antigenic shift vs antigenic drift?

Antigenic shift – cross-species reassortment (causes pandemics, only strain A)

Antigenic drift - point mutations from year to year (reason for yearly vaccine)

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What is reye’s syndrome?

give kid with influenza aspirin -> they get hepatitis, encephalopathy

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What is role of fusion protein in paramyxoviridae?

promotes viral fusion to host cell membrane

- promotes host cells to form –> syncytia [giant cells]

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Where do binding proteins of paramycoviridae bind?

sialic acid

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What is struct of paramyxoviridae?

enveloped
neg ssRNA
linear
non-segmented
helical capsid

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What are the paramyxoviruses? mnemonic?

PRM3

parainfluenza
RSV
Measles
Mumps
Metapneumovirus

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Which viruses have HN combo protein?

mumps and parainfluenza = same activity as HA and NA but in single protein

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What should you think: 4 yo bo to ER with resp distress, runny nose, baring cough of two days, resp stridor on inspiration?

parainfluenza = croup

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What are two leading causes of bronchiolitis in infants?

2. human metapneumovirus

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What are the two leading causes of common cold?

rhinovirus, coronavirus

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What is #1 cause of diarrhea in kids in US and world?

rotaviurs

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WHat is main virulence factor of rotaviurs?

NSP4 enterotoxin

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What is morphology of rotavirus?

non enveloped [naked]
segmented
dsRNA

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What is #1 cause of diarrhea in adults worldwide?

norovirus

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What is secretor negative phenotype of norovirus? asymptomatic carriers

have mutation in FUT2 gene so resistant to being infected = totally immune
asymptomatic carriers have the virus but no symptoms

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What are properties of enteroviruses?

enteroviruses = picornaviruses

very small
non-enveloped
stable at low pH [ie in GI]
- ssRNA
non segmented
transmit fecal-orally except rhinovirus

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What are the 5 enteroviruses? mnemonic?

poliovirus
Echovirus
rhinovirus
cocksacievirus A and B
hep A

PERCH

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What is #1 cause of CNS disturbances [encephalitis/meningitis] in summer?

enteroviruses!

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Where does poliovirus travel?

from GI via motor neurons to anterio horn of spinal cord

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What is significant about structure of enterovirus VP1 protein?

hidden in canyon = hides RBS from antibodies so harder to get immune response

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What are the two different vaccine options for polio?

IPV = salk = killed

OPV [oral] = sabin = live

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What diseases should you think with cosackie A?

herpangina [vesicular lesions on soft palate = back of mouth vs herpes is front]
hand foot and mouth diseases [rash, papules in palms, soles, and mouth]
all enteroviruses –> mengititis in summer

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What diseases should think think with cocksackie B?

pleurodynia [significant sharp pain with inspiration, fever]
myocarditis/pericarditis
all enteroviruses –> meningitis in summer

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What do you see in CSF with bacterial meningitis [protein, glucose, WBC types, pressure]?

protein: very high
glucose: very low
cells: high WBC, mostly neotrphils
pressure: high

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What do you see in CSF with fungal meningitis [protein, glucose, WBC types, pressure]?

protein: a little high
glucose: a little low
cells: mostly lymphocytes
pressure: high

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What do you see in CSF with viral meningitis [protein, glucose, WBC types, pressure]?

protein: normal or a little high
glucose: normal
cells: high WBC but not as high as bacterial, mostly lymphocytes
pressure: normal

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If you have high protein, low glucose, and mainly lymphocytes what should you think in CSF?

fungal meningitis

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If you have high protein, low glucose, and mostly PMNs what should you think in CSF?

bacterial meningitis

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What are possible symptoms of acute hepatitis?

pain in upper right quadrant
N/V
jaundice
fatigue
itching

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What is mnemonic for hepatitis virus associations?

A = Acute
B = Blood, Birth
C = Chronic, Cancer
D = Dependent
E = Expecting, Epidemic

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What is used to diagnose acute vs prior HAV infection?

acute = anti HAV IgM
prior/vaccination = anti HAV IgG

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What picornavirus is associated with shellfish outbreaks?

Hep A

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What type of vaccine is HAV vaccine?

killed vaccine

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Which of the Hep viruses can be chronic?

B, C, D

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Which hepatitis viruses have vaccines?

A and B

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What is treatment for Hep B?

Peg-IFNa + NRTI [lamivudine, entecavir, or tenofovir]

tenofovir has least resistance

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Pt comes in with
HBc-IgM =   +
HBc-IgG =    - 
HBs Ag =    + 
Anti-HBs =   -
Hbe Ag =    +
Anti-Hbe =   -

Are they: acute, window, resolved, chronic, or vaccinated?

acute infection

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Pt comes in with
HBc-IgM =    -
HBc-IgG =    - 
HBs Ag =     - 
Anti-HBs =   +
Hbe Ag =     -
Anti-Hbe =   -

Are they: acute, window, resolved, chronic, or vaccinated?

vaccinated

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What does positive HBsAg mean in Hep B?

surface antigen = pt has current HBV infection

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What does positive HBc-IgG mean in Hep B?

indicates resolved exposure

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What does positive HBc-IgM mean in Hep B?

indicates acute exposure

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What does positive Anti- HBs mean in Hep B?

indicates immunity [either from exposure or immunization]

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What does positive Hbe Ag mean in hep B?

indicates patient is contaneous

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Pt comes in with
HBc-IgM =    -
HBc-IgG =    + 
HBs Ag =     - 
Anti-HBs =   +
Hbe Ag =     -
Anti-Hbe =   +

Are they: acute, window, resolved, chronic, or vaccinated?

resolved

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Pt comes in with
HBc-IgM =    - or +
HBc-IgG =    +
HBs Ag =     - 
Anti-HBs =   -
Hbe Ag =     - or +
Anti-Hbe =   - or +

Are they: acute, window, resolved, chronic, or vaccinated?

window

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Pt comes in with
HBc-IgM =    -
HBc-IgG =    + 
HBs Ag =     + 
Anti-HBs =   -
Hbe Ag =     - or +
Anti-Hbe =   - or +

Are they: acute, window, resolved, chronic, or vaccinated?

chronic

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What are examples of prion diseases? effects?

human: creuzfeld-jakob, kuru
- infectious form of normal brain protein [PrP] –> slow but progressive dementia, neuro degeneration, die within 6 mos of onset

from eating brain, exposure to animal form

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What virus associated with SARS?

coronavirus

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What are symptoms of SARS?

fever
pneumonia/resp distress
diarrhea
leukopenia

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What are two most frequent causes of common cold?

coronavirus

rhinovirus

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When is metapneumovirus most common?

winter

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Adenovirus: what clinical syndromes should you think

conjunctivitis + pharyngitis
maybe diarrhea
outbreaks in military

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Which respiratory virus can also be transmitted fecal-oral?

adenovirus = very contagious

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What is struct of coronavirus?

positive
single strand RNA
enveloped

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What is struct of influenza?

negative
single strand
RNA
segmented
enveloped

“BRR because you get it in the winter and its cold and negative temperature and its RNA. you keep seeing these new segments about it and you wish you were enveloped in a sweater.”

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Which type of influenza treatment works for both A and B? Which for just A?

NA inhibitors for both –> zanamivir, oseltamivir

M2 blocks for A –> amantadine

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What is relation guillan barre and influenza vaccine?

don’t give influenza vaccine to person with recent guillan barre

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What is unique about HIV genome?

2 copies of + sense ssRNA = diploid

- caries its own reverse transcriptase, protease, intragrase

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Who is the biggest growing population of HIV + in the US?

most new infections blacks and latinos

- increasing % through het sex

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Where does polio infect?

brain –> encephalitis/paralysis

meninges –> meningitis

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Where does echo infect?

meninges –> meningitis
skin –> rash
muscle –>

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Where does hep A infect?

liver

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Where does cox A infect?

skin –> rash herpangina, hand food mouth disease

muscle –> pleurodynia [but mostly this is cox B]

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Where does cox B infect?

muscle –> pleurodynia, myocarditis, pericarditis

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Which is the only enterovirus with immune mediated mech rather than cytolitic?

Hepatitis A

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What are the roles of secretory IgA and serum IgG in enterovirus immune response?

sec IgA: prevents establishment of initial infection

serum igG: prevent/control viremia

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What is most frequent cause of common cold?

rhinovirus

also causes pharyngitis, otitis media

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What is major vector of rhinovirus?

hands!

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What is rhinovirus common?

early autumn, late spring

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Where does polio travel to?

anterior horn of spinal cord

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What is mech of CCR5 antagonists? ex?

prevent gp120 and CD4 CCR5 fusion

- mariviroc

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What is mech of integrase inhibitors? ex?

prevent insertion viral dsDNA into host genome

- raltegravir

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What is an example of nucleotide reverse transcriptase inhibitor? importance?

tenofovir

- less toxic than nucleoside or non-nucleoside

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What is mech of nucleoside reverse transcriptase inhibitors?

look like normal nucleosides and competitively inhibit RT

- cause chain termination because lack 3’-OH group

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What are the 5 NRTIs? mnemonic? KNOW THIS!

ZELAT

zidovudine
emtricitabine
lamivudine
abacavir
tenofovir

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What are the 2 NNRTIs?

nevirapine

- efavirenz

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What happens to HIV without pol gene [protease]?

HIV can’t cleave proteins to make new viruses = not infective

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What is purpose of ritonavir?

booster to inhibit degradation of protease inhibitor
acts as cytochrome p450 inhibitor
extends half life of PI –> less pills needed

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What type of HIV drugs have VIR in the middle usually [exception maraviroc and enfuviritide]?

NNRTIs!

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What types of HIV drugs contain navir? tegra?

navir = protease inhibitors
tegra = integrase inhibitors

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What are the 2 protease inhibitors we talked about?

atazanavir

- darunavir

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What is mech of action enfuviritide?

envelope fusion blocker –> HIV cant get into cell to infect

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What is side effect of abacavir? What type of pt should you avoid giving it to?

hypersensitivity rxn in pts with HLA-B5701

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Which two NRTIs are preferred in ARV-naive patients?

FTC [emtricitabine]

- TDF [tenofovir]

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What is major side effect of tenofovir?

renal toxicity

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What are the downsides of NNRTIs?

resistance develops easily

- all have interactions with CP450

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What are the side effects specific to efavirenz?

neuropsychiatric symptoms
teratogen [avoid in pregnant]
lipid elevation

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What are the side effects of PI?

GI disturbances
metabolic syndrome
CYP450 interactions
lipodystrophy

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What are side effects of atazanavir?

can cause jaundice [without causing liver injury] = hyperbilirubinemia [main effect]
kidney stones

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What is prophylactic treatment for pneumocystis jiroveci in HIV? when do you give it?

TMP-SMZ

- give when CD4 < 200

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What is prophylactic treatment for mycobacterium avium complex in HIV? when do you give it?

azithromycin

- give when CD4 < 50

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What type of vaccine is Hep A?

killed whole virus

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What type of vaccine is HPV?

recombinant protein subunits

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What type of vaccine is rabies?

killed whole, can give as part of PEP

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What type of vaccine is influenza?

killed whole = injected

- live attenuated = intranasal

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What type of vaccine is polio?

salk = killed whole –> inject before school entrance, no mucosal immunity

sabin - live attenuated, fewer doses than salk

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What type of vaccine is Hep B?

recombinant protein subunits

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What type of vaccine is MMR?

live attenuated

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What type of vaccine is yellow fever?

live attenuated

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What type of vaccine is vzv?

live attenuated

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what type of vaccine is rotavirus?

rotateq = live human-bovine reassortment, pentavalent

rotarix = live human attenuated, monovalent but cross-protection

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What are things you can give Ig passive immunity for?

hep A [IVIg]
hep B [hep B Ig]
rabies [rabies Ig]
varicella [varicella Ig]
RSV [palivizumab]

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A 4 year old presents to your clinic with a maculopapular rash that her mother states began on her face and has been spreading down her body. You note blue-white spots on examination of the child’s buccal mucosa. What is the most likely explanation for why your patient was susceptible to this infection?

A. The child has a history of splenectomy.
B. The mother had an infection while she was pregnant with the child.
C. The child’s vaccines are not up to date.
D. The child spends time outside while mosquitoes are out.
E. Nothing in particular; this is a common infection in kids.

C = vaccines not up to date

pt has measles which is preventable by MMR

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What should you think: 16 yo, swollen cheeks, stiff neck?

mumps

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What are 3 major symptoms of mumps?

aseptic meningitis
parotitis
orchitis

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what should you think: baby with patent ductus arteriosus, purpura look like blueberry muffin rash, impaired hearing/vision?

congenital rubella

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How do you get congenital rubella?

mom infected with rubella in 1st trimester

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What should you think: fever followed by descending rush?

rubella

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what is clinical syndrome described? cause?

7 vesicular lesions on soft palate, high fever, sore throat

herpangina

caused by coxsackie A

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What is this disease: Personality changes, progressive intellectual deterioration, motor and autonomic nervous system dysfunctions

SSPE = subacute sclerosing panencephalitis

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What is mech of transmission of measles?

aerosols

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Which of the following describes RSV?

A. It creates a complementary copy of its genome using an RNA-dependent RNA polymerase associated with the virion.
B. It reverse transcribes its genome using an RNA-dependent DNA polymerase
C. It utilizes cellular ribosomes to directly translate from its genome using cellular machinery.
D. The (-) sense strand of its double stranded genome is used as a template by virion-associated core enzymes
E. It transcribes its genome into messenger RNA using the infected cell’s DNA dependent RNA polymerase

A. It creates a complementary copy of its genome using an RNA-dependent RNA polymerase associated with the virion.

RSV = negative sense RNA genome

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Which of the following describes HIV?

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Which of the following describes poxvirus?

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Which of the following describes rotavirus?

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What is the most common cause of bronchiolitis in infants?

RSV

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Which virus: It causes inflamed lymph nodes, parotitis, and encephalitis in un-vaccinated children

mumps

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Which virus: It causes a distinctive, barking cough

parainfluenza

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Which virus: Causes inflamed conjunctiva, cough, and distinctive lesions in the mouth and rash

measles

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Which virus: Linked with deafness, cataracts, congenital heart defects like a patent ductus arteriosus if the mother is infected in the first trimester

rubella

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Which of these do susceptible infants receive prophylaxis for?

A. RSV
B. mumps
C. parainfluenza
D. measles
E. rubella

A RSV

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What should you think: kid with meningitis with CSF with mostly lymphocytes, normal protein and glucose in summer?

enteroviuses = major cause of asceptic meningitis in summer months

ex. cox A [or B]

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Look for IgM or IgG for acute infection?

IgM

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A 3 year-old-boy is brought to the emergency room at 2:00am by his parents who are worried by his persistent, hoarse cough, from which he is barely able to catch his breath. You order a chest and neck x-ray and note a narrowed trachea. What is this syndrome called? cause?

this is croup –> due to parainfluenza

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What type of virus is parainfluenza?

paramyxovirus

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What are characterisics of coronavirus?

+ sens RNA

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What causes SARS?

coronavirus

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What is viral family of Hep C?

flaviviridae

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Match these: HSV1, Picornavirus [coxsackie], Poxvirus [smallpox]

A. dsDNA virus complex lipid envelope
B. dsDNA virus enveloped and isocahedral
C. pos ssRNA virus naked and nonsegmented

A –> poxvirus

B –> HSV1

C –> picornavirus

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What are major viral causes of neonatal encephalitis?

HSV1
HSV2
CMV

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What should you think: neonatal encephalitis with abnormalities in temporal lobes bilaterally?

HSV

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What is mode of transmission HSV from mother to child?

usually through infected birth canal

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How do you treat neonatal herpes encephalitis?

acyclovir

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A newborn born at 30 weeks’ gestation is admitted to the neonatal ICU 10 days after birth because of a high fever and a seizure. His mother states that she did not receive prenatal care during her pregnancy. Physical examination of the newborn shows a diminished sucking reflex, which was normal at birth. Examination of the CSF shows a increased mononuclear cells and elevated protein levels. A PCR test of the CSF is completed, but the results are pending. An MRI of the brain is performed, which shows abnormalities in the temporal lobes bilaterally. Which of the following is the most important factor in the development of this infection?

A. Absence of antibodies in the mother
B. Exposure of the mother to poorly cooked pork
C. Passage through an infected birth canal
D. Three-day rash in the mother
E. Transplacental transmission

C = this is HSV

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What are major types of drug combos in an HAART regimen?

need at least 2 classes

usually:

2 NRTI and 1 PI
2 NRTI and 1 NNRTI

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Which of the following is an appropriate HAART regimen for someone who has never received therapy for HIV?

a) Zidovudine and Raltegravir
b) Lamivudine, Emtricitabine, and Tenofovir
c) Efavirenz, Fosamprenavir, and Maraviroc
d) Lamivudine, Emtricitabine, and Efavirenz
e) Emtricitabine, Tenofovir, and Darunavir

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Is this a valid HAART regimen: Lamivudine, Emtricitabine, and Tenofovir

why or why not?

these are all NRTIs

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Is this a valid HAART regimen: Efavirenz, Fosamprenavir, and Maraviroc

why or why not?

there is no NRTI

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Is this a valid HAART regimen:
Lamivudine, Emtricitabine, and Efavirenz

why or why not?

no
- this is two NRTI and an NNRTI

BUT: lamivudine and emtricitabine are contra-indicated to give together because both analogues of cytidine = redundant mech of action

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Which HIV med has adverse side effects including nephrolithiasis or kidney stones?

atazanavir

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What are signs of kidney stone?

flank pain
costovertebral angle tenderness
hematuria without casts

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What do NK cells recognized?

cells that have downregulated MHC1 at potentially infected

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What virus is associated with congenital deafness?

rubella

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What is most common congenital infection in US?

CMV

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What are the four virus families that are segmented? mnemonic?

BOAR

bunya [ex hantavirus]
orthromyxo [ex. influenza]
arena
reo [ex rotavirus]

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Which of these is segmented:
A. Coronavirus
B. HIV
C. Measles virus
D. Rabies virus
E. Rotavirus
F. Rubella virus
G. St. Louis encephalitis virus

E. rotavirus

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When do you use cidofovir/foscarnet?

treating CMV in immunocompromised when virus is resistant to first line agents

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What virus is associated with development of B cell lymphoma [ex burkitt’s lymphoma]?

EBV

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What is heterophile-positive mono?

heterophile positive = non-specific IgMs that are produced in response to acute EBV

thus this is EBV related mono

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What is structure of rotavirus [stranded, non/segmented, dna/rna]?

double stranded
segmented
RNA

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What is guillain barre associated with?

CMV, campylobacter

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What are some things associated with EBV infection?

mono
burkitts lymphoma
oral hair leukoplakia
hodgkins lymphoma
nasopharyngeal carcinoma

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What type of virus causes secretion of immunosuppressive cytokines?

EBV

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What type of virus causes cytokine receptor decoys?

poxvirus

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What type of vaccine is rotateq? valence?

live human-bovine reassortment

- pentavalent

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what type of vaccine is rotarix? valence?

live human attenuated

- monovalent but provides cross protection

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How does HPV avoid immune detection?

does not infect APCs

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What is function of HPV E6 and E7 proteins?

both oncogenic tumor suppressors

E6 = inhibits p53
E7 = inhibits Rb

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What are HPV strains 6/11 associated with?

genital warts [condyloma acuminatums], CIN1

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What are HPV strains 16/18 associated with?

cervical cancer, anal cancers, oral cancer

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Whats in cervatrix? gardasil?

cervatrix = bivalent 16/18
gardasil = tetravalent 6/11/16/18

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What is structure of togaviruses?

single strand
pos
RNA
linear
icosahedral

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What is structure of flavivirus?

single strand
pos
RNA
linear
icosahedral

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What is structure of bunyavirus?

single strand
neg
RNA
circular
helical

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What is vector of dengue?

aedes aegypti mosquitos

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What is vector of yellow fever?

aedes aegypti mosquitos

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What are examples of flaviviruses?

yellow fever
dengue fever
west nile virus
st louis encephalitis

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What are the viral agents of enceophalitis? mnemonic?

HEMP AIR

H = herpes virus [HSV-1]
E = equine encephalitis [eastern + western +  venezuelen + other arboviruses -- west nnile, st lous, la crosse]
M = measles/mumps
P = polio and other enteroviruses

A = Adenovirus
I = Influenza
R = rabies

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What is the primary pathologic feature of WNV in CNS?

multifocal encephalitis

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What is post exposure prophylaxis for rabies?

human rabies Ig and rabies vaccine

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What virus is being described? Is there a vaccine?

A virus that destroys neurons in the anterior tract of the spinal cord

this is polio

- there is a killed vaccine [salk] and a live vaccine [sabin]

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What virus is being described? Is there a vaccine?

A common childhood virus that presents with fever and rash and can reoccur in adulthood

this is varicella

- there is a live vaccine

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What virus that has a live vaccine is being described?

An enveloped togavirus

this is rubella

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What virus is being described? Is there a vaccine?

A zoonotic virus that infects neurons in muscle and travels to infect the CNS

rabies

yes there is a killed, whole virus vaccine

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What virus is being described? Is there a vaccine?

A flavivirus carried by the same mosquito as the one carrying Dengue

this is yellow fever

- there is a live vaccine

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Q: A woman who has recently returned from a city in Southeast Asia presents to her physician with sudden-onset of fever and pain that occurs when she moves her eyes. She also complains of severe muscle pain in her back and extremities, as well as recent joint pain in her knees. Physical Exam reveals an erythematous rash that covers her face and body along with generalized lymphadenopathy. What is the disease and vector for this disease?

disease = dengue fever [she has breakbone fever]

- vector = aedes aegypti

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After getting dengue fever are you immune from it in the future?

No– four different serotypes and you only develop antibodies to particular type you have

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A 25-year-old man presents to your infectious disease clinic. He is complaining of backache, fever, and fever. On exam he has a morbilliform rash. On taking further history, you discover that one week ago he returned from a research trip to Papua New Guinea, where he was studying indigenous people. While witnessing a tribal feast he was offered some strange food, and not wanting to offend his hosts, he sampled everything. What does the patient have?

Dengue fever

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A 38 year old woman with HIV presents to the ED with fever, headache, and blurred vision. CSF analysis shows increased opening pressure, lymphocytosis, increased protein, and decreased glucose.
What does she have? What is her likely CD4 count?

fungal meningitis

- likely CD4

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What is the most common cause of fungal meningitis?

cryptococcus

Are hyphae molds or yeast?

molds

What should you think when you see cryptococcus neoformans?

meningitis in HIV pt

What fungus is associated with pts receiving total parenteral nutrition [TPN] through some sort of central line?

candida albicans

What is role of melanin in cryptococcus neoformans?

evades antifungals

What does it mean: HITS and BLASTS hole in mississipi

histoplasma and blastomyces in mississipi and ohio river valleys

What does it mean: COCKS his pistol in the old SOUTHWEST

coccidioides in southwest and mexico

How do you treat histoplasma?

amphotericin B then itraconazole or voriconazole

What fungi is associated with broad based budding?

blastomyce dermatidis

What is treatment for blastomyces dermatitidis?

amphotericin B, itraconazole, fluconazole

What causes san joaquin valle fever?

coccidioides immitis

What are symtoms of san joaquin valley fever?

rash, erythema nodosum, erythema multiforme, joint pain, conjunctivitis

What is the role of arthroconidia in coccidioides immits?

arthroconidia = barrel shaped infectious unit

- get inhaled by person and that they they become infected

See spherule what fungi should you think?

coccidioides immitis

How do you treat coccidioides immitis?

amphotericin B then fluconazole in immune compromised

What is mariner’s wheel morphology?

characteristic finding of paracoccidioides fungus

Are men or women more susceptible to paracoccidioides?

men! estrogen may be protective

When you hear paracoccidioides brasillensis what should you think?

mariners wheel
south america
pulmonary disease, lymphadenopathy

What is treatment for penicillium marneffi?

amphotericin B

- 5-fluorocytosine

When you see broad ribbon-like hyphae with right angle branching what should you think?

zygomycetes

What are the risk factors for getting a zygomycetes [rhizopus] infection?

DM [especially DKA]
desferoxamine therapy [treatment for iron overload]
neutropenia
bone marrow recipients
immunocompromised

Can voriconazole treat zygomycetes?

no! just aspergillus

How do you distinguish blastomyces dermatitidis from paracoccidioidomycosis? Both are endemic to latin america and cause pulm disease.

paracocidiodes –> yeast wtih multiple buds, afects males more than females
blastomyces –> single broad based budding

What is the most common cause of fungal meningitis?

cryptococcus neoformans

What are the 5 common pediatric diseases with rash?

measles
rubella
scarlet fever
roseola [HHV6]
erythema infectiosum [parvovirus B19]

What are the 3 common causes of pneumonia in adults?

s. pneumoniae
H influenza
legionella

What does cox A cause? cox B? what can they both cause?

A: herpangina, hand foot and mouth
B: pleurodynia, myocarditis, pericarditis
A or B: aseptic meningitis, paralysis, URI

What are the 3 most common causes of aseptic meningitis?

coxsackievirus
echovirus
mumps virus

What are the 5 most common causes of common cold?

rhinovirus
coronavirus
adenovirus
influenza C
cosackievirus

What are 3 things you could have if you have a palm and sole rash?

syphillis
rocky mountain spotted fever
coxsackievirus

What is the only type of RNA virus that is double stranded?

reoviruses [aka rotavirus]

Once you get rotavirus can you get it again?

No –> after infected have life-long immunity

Where is EEE [eastern equine encephalitis] localized?

swampy area in easter US

Where is WEE [western equine encephalitis] localized?

western and central US and canda

Where is VEE [venezuelan equine encephalitis] localized?

venezuela, colombia, central america, texas

What are the organsims that can corss the placenta? mnemonic

ToRCHES
TO = toxoplasma gondii
R = rubella
C = CMV
HE = HErpes, HIV
S = Syphillis

What type of cells does dengue infect?

macrophages

What is most common human disease caused by arbovirus?

dengue fever

What is most common cause of epidemic encephalitis?

japanese encephalitis

What is clinical syndrome of hantavirus?

hantavirus respiratory syndrome –> leads to respiratory failure and high mortality within 10 days

what drug should you not give to a kid with the flu?

aspirin –> causes reyes syndrome

What are two most common causes of pneumonia in young children?

2. parainfluenza

What is the only live vaccine that can be given to HIV positive?

MMR

What are the most common causes of conjunctivitis?

H influenza
adenovirus
s. pneumoniae

Where does HSV encephalitis tend to localized?

temporal lobe

What is most common cause of sporadic encephalitis in adults/neonates?

adults: HSV1
neonates: HSV2

Why do you have to treat CMV with ganciclovir and not acyclovir?

CMV has no viral thymidine kinase

When you see tiny yeast forms in macrophages what should you think?

histoplasma capsulatum

Match these

localized cutanous infection
spherules containing endospores in lungs
pilots wheel appearance of multiple yeasts sprouting from single parent
large round budding yeast free in tissues
hilar lymphadenopathy and multiple tiny yeast forms within macrophages

A. Blastomyces dermatitidis
B. Coccidioides immitis
C. Histoplasma capsulatum
D. Paracoccidioides brasiliensis
E. Sporothrix schenckii

1 = E. Sporothrix schenckii

B. Coccidioides immitis
D. Paracoccidioides brasiliensis
A. Blastomyces dermatitidis
C. Histoplasma capsulatum

When you hear spherules with endospores what should you think?

coccidioides immits

Diarrhea caused by protozoa – match characteristic to source

bloody
fatty
watery

A. giardia fambfia
B. entamoeba histolytica
C. Cryptosporidium
parvum

Blood = entamoeba histolytica
fatty = giardia fambfia
water = cryptosporidium parvum

What should you think: AIDS patient with mental status change and Head ache, Brain CT show multiple ring enhancing lesions.

toxoplasma gondii

What is most common cause of encephalitis in HIV?

toxoplasma gondii

What is relation sickle cell and malaria?

sickle cell trait protects against P. falciparum [RBCs too weak to support parasite]

What is relation duffy antigens A and B and malaria?

RBCs lacking duffy antigens can’t be infected –> protozoa bind to these antigens

What is relation thalessemia and malaria?

What is relation G6P phosphate dehydrogenase deficiency and malaria?

What is most pathogenic form of malaria?

plasmodium falciparum

What type of RBCs does each of the four types of malaria [falciparum, vivax, ovale, malariae] infect?

falciparum: RBCs of any age
vivax: reticulocytes only
ovale: reticulocytes only
malariae: aging RBCs only

Which type of malaria can persist in blood 20-30 yrs after infection?

plasmodium malariae

What is the size of cells infected by each of the four types of malaria [falciparum, vivax, ovale, malariae]?

falciparum: normal size
vivax: greatly enlarged
ovale: slightly enlarged with oval shape
malariae: normal size

What type of drugs can be malaria prophylaxis?

doxycycline
mefloquine
atovaquione-proguanil
+ primaquine in vivax/ovale areas

What is first choice malaria drug? second choice if resistant?

first choice: chloroquine
if resistant: mefloquine

if ovale/vivax also give primoquine

What is problem with using primoquine?

can’t use if G6PD deficiency

What type of drug do you use if life threatening falciparum malaria?

IV quinidine + IV doxycycline

What are the 4 intestinal worms with migratory phase in lungs?

ascaris lumbricoides
necator americanus [hookworm]
ancyclostoma duodenale [hookworm]
strongyloides stercorales

What does pyrantel pamoate treat? mech?

treat pinworm

- depolarizing blocker of NMJ

How do you distinguish taenia solium from saginata?

solium = has hooks on scolex, fewer uterine branches

saginata = no hooks on scolex, more uterine branches

What causes a hydatid cyst?

ingestion of feces contaiminated with eggs of dog tapeworm [echinococcus granulosus]

What animal is T. solium associated with?

pigs

What animal is T. saginata associated wtih?

cattle

What animal is D. latum associated with?

fish

What animal[s] is F. granulosus associated with?

sheep and dogs

When you hear hookworm what should you think?

childhood anemia in developing country

Where is schitosome mansoni located? clinical manifestation?

in Africa/Brazil

- liver problems

Where is schitosome hematobium located? clinical manifestation?

Africa [Egypt]

- bladder problems

Where is avian schitosome located? clinical manifestation?

Canada/northern waters

- swimmers itch

What should you associated with onchocerca volvulus? 2 mnemonics/phrases

black flies, black skin nodules, black sight

treat rIVER blindness with IVERmectin

What causes elephantitis?

wuchereria bancrofti

Which parasite should you think if you see maltese cross in RBC?

babesia microti

A 46-year-old woman with a history of diabetes comes to the physician because of a severe prefrontal headache. Physical examination shows swelling of the orbit of the left eye and a black nasal discharge.

What should you think? Silver stain of nasal discharge will show what?

zygomycosis –> DKA is risk factor for rhinocerebral infection
nonseptate ribbon like hyphae branching at 90 degrees

What should you think: tiny ovals within macrophages in mass lesion in lung, have chronic cough, ohio river valley?

histoplasma capsulatum

Which of these can look like miliary TB?
A. coccidioides
B. sporothrix
C. blastomyces
D. trichinella
E. histoplasmosa

E. histoplasma

Match these:
A. coccidioides
B. sporothrix
C. blastomyces
D. trichinella
E. histoplasmosa

lives in ohio river valley; explores caves
lives in great lakes, spends time outside
lives in arizona/new mexico, flu like illness
spends most of time working in garden
hunter enjoys venison sausage

A. coccidioides == 3. lives in arizona/new mexico, flu like illness

B. sporothrix == 4. spends most of time working in garden

C. blastomyces == 2. lives in great lakes, spends time outside

D. trichinella == 5. hunter enjoys venison sausage

E. histoplasmosa == 1. lives in ohio river valley; explores caves

What should you think: cave exploring in ohio?

histoplasma [from bat guano]

What should you think” spherules packed with endospores in lung?

coccidioides immitis

A huge mass estimated at 800 worms has been found in the obstructed part of small intestine of a 2-year-old girl from South Africa. The adult worm of this species is approximately 15 to 35 cm in length. The larvae of the parasite are known to migrate to the lung and cause pulmonary infiltration and eosinophilia (PIE) syndrome. What is the most likely organism?

A. Ascaris lumbricoides
B. Diphyllobothrium latum
C. Enterobius vermicularis
D. Strongyloides stercoralis
E. Trichinella spiralis

A. ascaris lumbricoides

Can you prevent malaria in africa with chloroquine? what about malaria in caribbean/central America?

not in africa

- only place in world basically that you can use chloroquine as prophylactic = caribbean/central America

What prophylaxis should you use for malaria for trip to africa?

atovaquone/proguanil [malarone] plus primaquine depending where you’re going

What fungus is associated with pigeons? Can it infect immunocompetent?

cryptococcus neoformans

- major cause of meningitis in HIV but also can cause lung disease in normal person with big inoculum

What would you expect on PCP pneumonia xray?

patchy all over, not big focal consolidations

What is the one trematode you don’t treat with praziquantel? What do you use instead?

fasciola hepatica

use veterinary form of triclabendazole

What should you think: papule with thrombosed capillaries [black dot]?

HPV infection = wart or conyloma acuminatum

What should you think: slapped cheek rash?

human parvovirus B19

What should you think: crop of vesicles on erythematous base? treat?

herpes = HSV1 or 2

treat with acyclovir

What is treatment for varicella zoster?

acyclovir or foscarnet

What should you think: dew drop rose petal rash of different ages?

VZV

What causes erythema infectiosum? another name for it?

human parvovirus B19

- other names: fifth disease, slapped cheeks

What should you think: umbilicated papule?

poxvirus

What should you think: hyper and hypo pigmentation with fine scale on chest and back?

pityrosporum orbiculare

What do you use to treat mucocutaneous and esophageal candidiasis?

fluconazole

When do you give prophylaxis for MAC? What do you give?

CD4 < 50, give azithromycin

When do you give prophylaxis for toxo? What do you give?

CD4<100, give TMP/SMX

What happens in JC virus?

demyelinating disease in AIDS

What is effect and treatment of CMV in AIDS/post BMT? treat?

retinitis in AIDS
fulminate hepatitis, pneumonitis, esophagitis
treat wtih ganciclovir

When should you worry about esophageal candidiasis in HIV?

CD4 < 100

When should you worry about CMV retinitis in HIV?

CD4 < 50

What are signs of congenital toxo? how is it transmitted?

classic triad: chorioretinitis,
intracranial calcifications, hydrocephalus

crosses placenta

What are signs of congenital rubella? how is it transmitted?

low birth weight, blueberry muffine rash, blindness, patent ductus arteriosis

What is struct of bacillus anthracis?

gram pos, spore forming bacillus

What is struct of yersinia pestis?

gram neg bacillus with safety pin appearance

What is struct of variola major?

large brick shaped DNA virus

What is struct of filoviruses [ebola]?

enveloped
negative ss RNA
nonsegmented
helical capsid

What is struct francisella tularensis?

poorly staining

- gram neg coccobacillus

What are signs of anthrax?

inhalation = flu like --> mediastinitis, shock, death
cutaneous = black eschar
ingestion = bowel necrosis, hemorrhage, edema

What are signs of ebola? how is it transmitted?

hemorrhagic fever, high mortality

transmit via direct contact with body fluids

What are signs of tularemia?

pulm tularemia from inhalation

What is treatment for bacillus anthracis?

within 24 hrs PCN or cipro

What parasite associated with sushi?

diphylobotrium latum

What is effect of diphylobotrium letum?

fish tapeworm = B12 deficiency, high MCV, hypersegmented neutrophils = megaloblastic anemia

What parasite associated wtih vomica?

echinococcus granulosus [dog tapeworm]

What parasite causes hyatid cysts?

echinococcus granulosus [dog tapeworm]

A 45-year-old man presents with jaundice and abdominal pain in the right upper quadrant. His disease began a week earlier with cough, followed by fever, nausea, vomiting and diarrhea. The patient’s travel history is remarkable for frequent trips to South America. Physical examination reveals a jaundiced man in no apparent distress. Guarding and tenderness are noted in the right upper quadrant. The liver span is 15 cm. Laboratory findings are remarkable for white blood cell (WBC) count of 18,500/mm3, with 36% PMNs, 9% lymphocytes, 3% monocytes and 52% eosinophils. Stool examination for ova and parasites is shown in the figure. What is the most likely diagnosis?

A. Ascaris lumbricoides
B. Clonorchis sinensis
C. Fasciola hepatica
D. Schistosoma mansonii
E. Trypanosoma cruzi

C. Fasciola hepatica

Bear Grylls’ son, Bear-cub Grylls, parachutes into your clinic complaining of a stomach ache, feeling tired, short of breath, and generally weak. A few months ago he had been shooting a Man vs. Wild Junior episode deep in the Nigerian jungle. Which is the helminth likely causing his symptoms?

necator americanus [hookworm] = caues childhood anemia in developing countries

What is clonorchis sinensis? what is it associated with?

chinese liver fluke –> associated with obstruction in biliary tree, increased risk cholangiocarcinoma

A man in his early 30’s who recently emigrated to the US from Japan presents with jaundice and intermittent abdominal pain. His blood work shows a high eosinophil count, and an ultrasound of his abdomen reveals dilation of his bile ducts. The doctor suspects infection with an organism that can cause both of obstruction bile ducts, and a predisposition to bile duct cancer (“cholangiocarcinoma”).

Which of the following bugs does the doctor suspect?

A) Ascaris Lumbricoides
B) Schistosoma mansoni
C) Entameba histolytica
D) Clonorchis sinensis
E) Cryptosporidium parvum

D) Clonorchis sinensis

A 25 year old female comes into the clinic complaining of green discharge, along with itching and burning in her vagina. The discharge is foul smelling. On wet mount, motile organisms are observed. She is most likely infected by:

a. trichomonas vaginalis
b. garnderella vaginalis
c. chalmydia trachomatis
d. Neisseria gonorrhea
e. HPV

a. trichomonas vaginalis

A young man presents to the clinic after a camping trip. He complains of diarrhea, flatulence, and foul smelling fatty diarrhea.

What does he have? treat?

fatty smelly diarrhea + camping = giardia lambila

treat with metronidazole

What should you think: dilated esophagus, sigmoid colon, and ureter?

trypansoma cruzi

A 54-year-old man, who has been HIV positive for 15 years, presents to the Emergency Department with seizures and confusion. His CD4+ to CD8+ ratio is

D. Toxoplasma gondii infection

What parasite is a major cause of severe diarrhea in AIDS?

cryptosporidium

A male neonate born to a 32-year-old woman presents with chorioretinitis, hydrocephalus, and intracranial calcifications. His mother denies sick contacts or recent travel but notes that she has a cat at home. What is the most common mode of transmission in normal hosts?

A. Contaminated water
B. Canned food
C. Undercooked meat
D. Sexual transmission
E. Respiratory droplet

C. Undercooked meat = toxoplasma, from undercooked meat or cat poop

What should you think: Seizure, fever, prefrontal headache, altered sese of smell 2 weeks after freshwater lake exposure

naegleria fowleri

A Brazilian child from one of the shantytowns outside Sao Paulo presents with fever and a massively swollen abdomen. His mother reports that despite the size of his belly the boy has been losing weight and that his skin has grown dark and dusky. Bloodwork reveals anemia and hypergammaglobulinemia. Which of the following is most likely true?

a. The abdominal distention is caused by the massive proliferation of parasites within the boys’ intestines
b. The boy’s illness was caused by the bite of a Reduviid bug
c. The boy’s illness was caused by the bite of a Tse Tse fly
d. The boy had a cutaneous lesion several months ago

d. The boy had a cutaneous lesion several months ago

this is visceral leishmaniasis, grey skin = sign of dum dum fever

A 48 y.o. African woman comes into clinic struggling to keep her eyes open. She has a string of enlarged lymph nodes along the back of her neck, and she complains of fever, joint pains and itching. It’s 6pm and she told you she just woke up for the day. You show her a picture of a Tsetse fly and she recognizes it immediately as something that bit her a couple of weeks ago. What are you going to treat her with?

A. Suramin and Melarsoprol
B. Nifurtimox
C. Mebendazole
D. Praziquantel
E. Chloroquiine

A. Suramin and Melarsoprol

How is trichomonas vaginalis transmitted?

sexually

Is the protozoan transmitted by tsetse fly more acute in west or east africa? what is each called?

east = more acute = T. b. rhodiense
west = less acute = T. b. gambiense

Which 2 types of protozoa form kinetoplasts?

leishmania and trypanosomes

Do trypanosomes undergo antigenic variation?

yes!

What is rectal prolapse associated with?

trichuris

Microscopic examination of blood and/or tissue samples infected with which of the following parasites would NOT show diagnostic intracellular inclusions?
a. Plasmodium falciparum
b. Babesia microti
c. Trypanosoma brucei
d. Leishmania tropica
e. Leishmania brazilensis

c. Trypanosoma brucei = replicates in blood

Which of the following describes pneumocystis jiroveci?

A. A gram-positive, catalse-positive cocus
B. An encapsulated monomorphic fungus
C. An extracellular atypical fungus
D. An intracellular parasitic protozoan
E. An intracellular yeast

C. An extracellular atypical fungus

Damn right Flava flave in a toga, parties round the clock.

What does it mean?

Deltavirus retrovirus* flavaviruses togaviruses all enveloped icosahedral ( in a toga)

Picornaviruses rotavirus calicivirus all naked icosahedral

Call pico and flava flave, there’s a retro toga party with coronas

What does it mean?

All pos strand RNA viruses

-calicivirus, picornavirus, flavivirus, retrovirus, togavirus, coromavirus

What type of virus is JC virus?

polyoma virus

What type of virus is BK virus?

polyoma virus

A 4-year-old boy presents with fever and a generalized, confluent maculo-papular rash. The mother reports that he became sick 2 days ago with cough, runny nose and “pink eye” before the rash developed, and that 10 days prior he had been exposed to another child with a similar rash. He has not been vaccinated because his mother is concerned about the side effects of vaccines. On exam, in addition to the rash, you notice that the child is ill appearing and has gray, pin-point lesions in the buccal mucosa. Which is this disease? What is the main route of transmission of this disease?

A. inhalation of airborne aerosols
B. a tick bite
C. physical contact with the rash
D. fecal-oral
E. contact with fomites

This is measles

A. inhalation of airborne aerosols

During the month of January in New York, a 4-month-old infant born prematurely at 28 weeks gestation presents with fever, respiratory distress, noisy breathing and difficulty feeding. On exam you find him to be tachypneic, with an O2 sat of 90%, and in obvious respiratory distress. You can hear crackles and wheezes throughout all the lung fields. A rapid influenza tests is negative and a chest X ray shows hyperinflation but no focal infiltrate. What is causing this disease? How could the most likely infection causing this patient’s symptoms have been prevented?

A. Use of a live attenuated vaccine
B. Use of a killed (inactivated) vaccine
C. Use of a monoclonal antibody
D. Use of a prophylactic antiviral drug
E. Use of sterile water for formula preparation

This is bronchiolitis from RSV

C. Use of a monoclonal antibody [palivizumab]

When do you get RSV?

winter –> oct to april

During the month of August, a 24 year old woman from New York City presents complaining of fever, severe headache, and pain in the back of her neck. Although she overall looks well, given her symptoms you decide to do a lumbar puncture. CSF analysis shows the presence of 80 WBC, 90% of them lymphocytes, and a normal glucose and protein. Which is the main mode of transmission of the virus most likely to be causing her symptoms?

A. Close contact with saliva or genital secretions
B. Inhalation of aerosols
C. Fecal-oral transmission
D. Blood transfusion
E. Mosquito bite

C. Fecal-oral transmission

this is an enterovirus

A 16 year-old female has developed an immune mediated central nervous system disease known as anti-NMDA receptor encephalitis. Her neurologist wants to treat her with an anti-CD20 antibody known as rituximab. Because of the immunosuppressive effects of this agent, the neurologist decides to screen the patient for occult infections. Hepatitis B screening tests show:
HBsAb: +
HBcAb: -
HBsAg: -
HBeAg: -
HBeAb: -

A. Chronic  infection
B. Past Infection cleared
C. Immune from vaccination
D. Window Period
E. Acute Infection

C. Immune from vaccination

You are taking care of a 27 year old woman with HIV. She is receiving antiretroviral therapy, and although her viral load had previously been undetectable, it is now repeatedly above 10,000 copies/ml. After doing a genotype test you would like to switch her to a new regimen that includes the medication abacavir. Which of the following tests would be most important to perform prior to prescribing abacavir

A. CBC
B. Creatinine
C. Cholesterol
D. HLA B5701
E. Co-receptor  tropism assay

D. HLA B5701

get hypersensitivity rxn with abacavir in HLA 5701

What is major side affect of zidovudine?

anemia

What is major side effect of tenofovir?

renal insufficiency

What is major side effect of PIs?

hypercholesterolemia/met disease/lypdystrophy

What drug would you need to do a co-receptor tropism assay before prescribing?

miraviroc = CCR5 receptor blocker

need to check that pt HIV isnt using CXCR4

A 22-year-old male presents with a 5 day history of fever and sore throat. His past medical history is unremarkable and he reports a negative HIV tests 6 months ago. Physical exam is significant for an erythematous throat with enlarged tonsils, and enlarged lymph nodes bilaterally in the neck, axilla and groin. The liver transaminases are mildly elevated. A throat culture and EBV monospot (heterophile antibody) are negative. Which of the following would be most appropriate to test for HIV infection in this patient ?

A. HIV viral load (PCR)
B. HIV antibody
C. HIV culture
D. CD4 count
E. Total  Immunoglobulin level

A. HIV viral load (PCR)

this is the test has mono-like illnes = possible sign for acute HIV

What is mech of action acyclovir?

nucleoside analogue, DNA pol inhibitor

25-year old woman is pregnant and is seeing her obstetrician for prenatal care. She has a 1-year history of recurrent episodes lasting 3-5 days each of small, painful vesicles in the labia minora. What is the mechanism of action of an antiviral drug that can be used in late pregnancy to decrease the chances of this woman transmitting this infection to her newborn infant?

A. Attachment to the F protein
B. Neutralization of gB
C. Inhibition of viral DNA polymerase
D. Inhibition of viral thymidine kinase
E. Inhibition of viral RNA polymerase

C. Inhibition of viral DNA polymerase

this is HSV –> treat with acyclovir

What is side effect of acyclovir?

nephrotoxicity

A 5 year old boy presents with multiple crops of painful small vesicles on an erythematous base on his lips and perioral area, along with shallow ulcerations in the oral mucosa and gums. The pain is so severe that the child is unable to eat and needs to be admitted to the hospital for IV fluids. Which of the following is more commonly seen as a side effect of the first-line medication used to treat this infection?

A. Hepatotoxicity
B. Nephrotoxicity
C. Ototoxicity
D. Teratogenesis
E. Anemia

B. Nephrotoxicity

this is HSV, treat with acyclovir

What is minimum age for giving VZV vaccine?

1 year –> same with other live virus vaccines because mom’s immunity gets in the way

The mother of a 4-month-old infant calls your office saying that the child’s grandfather, who lives with them at home, was just diagnosed with shingles. What would you recommend to prevent infection of the infant by the virus causing her grandfather’s illness?

A. The grandfather should wear a mask at all times
B. The grandfather should avoid being in the same room with the child
C. The child should be immunized immediately
D. Contact between the infant and the grandfather’s skin lesions should be avoided
E. The grandfather should avoid preparing the infant’s bottle

D. Contact between the infant and the grandfather’s skin lesions should be avoided

this is VZV

zoster via direct contact transmission

You are evaluating a newborn infant who failed his routine hearing screen. This infant should be investigated for infection with which of the following viruses?

A. CMV
B. EBV
C. HHV8
D. Enterovirus
E. HIV

A. CMV

In 1957, 1968 and 2009 new influenza A virus strains emerged which caused pandemics. What was the most likely mechanism leading to the formation of these strains?

A. Mutations of avian strains
B. Reassortment between animal and human strains
C. Recombination between avian and porcine strains
D. Mutations of human strains
E. Splicing of genes of avian and human strains

B. Reassortment between animal and human strains

During a single week, 400 students at a High School with a total student body of 1600 students become ill with malaise, nausea, vomiting and diarrhea. Many of them also report a low grade fever. All of the students recovered within 24-48 hours without any further complications. Bacterial stool cultures done on a subset of students were negative. Which is the most likely cause of this outbreak?

A. Rotavirus
B. Norovirus
C. Enterovirus
D. Adenovirus
E. Influenza

B. Norovirus

= associated with outbreaks, 24-48 hrs of diarrhea

A 3-year-old girl is brought to her pediatirican because of fever to 105F of one day duration. On exam the child is irritable, but alert and with no other abnormalities on examination. You prescribed acetaminophen and ask the mother to bring the child daily to your office for close follow up. After 3 days the fever resolves and the child’s behavior returns to normal. That day her exam is significant for a generalized, erythematous, macular rash which resolves uneventfully after 2 days. What is causing this disease? Which component of the immune system makes reinfection with this same agent extremely unlikely in this patient?

A. Antibodies
B. CD8 cytotoxic lymphocytes
C. Type I Interferon
D. Defensins
E. Macrophages

this is roseola [HHV-6 or HHV-7]

A. antibodies

What should you think: kid younger than 3, high fever + irritability followed by general rash

roseola [HHV-6/7]

Which is the most critical general advantage of “live-attenuated” vs. “inactivated” viral vaccines?

A. Live viral vaccines induce both cell-mediated and humoral immunity, whereas inactivated viral vaccines induce mainly cell-mediated immunity
B. Live viral vaccines are associated with viral latency and, therefore, induce life-long immunity
C. Live viral vaccines induce both cell-mediated and humoral immunity, whereas inactivated viral vaccines induce mainly humoral immunity
D. In contrast to inactivated vaccines, live viral vaccines can be modified from one year to the next to account for genetic alterations in the target virus
E. Live viral vaccines can be administered earlier in life

C. Live viral vaccines induce both cell-mediated and humoral immunity, whereas inactivated viral vaccines induce mainly humoral immunity

A 35 year old man who will be travelling to Egypt asks about the type of vaccine used to prevent Yellow fever, its immunogenicity and potential adverse events. Which of the following statements are correct?

A. A live, attenuated virus vaccine is highly protective but on rare occasions lethal
B. A polysaccharide vaccine is safe but poorly immunogenic
C. A polysaccharide vaccine is highly protective but potentially lethal
D. A conjugate vaccine is safe but poorly immunogenic
E. A toxoid vaccine is highly protective but potentially lethal

A. A live, attenuated virus vaccine is highly protective but on rare occasions lethal

An asymptomatic 35-year-old woman goes for a routine gynecologic exam. Her physical examination is normal. A routine Pap smear is obtained which is reported as LSIL (low grade squamous intraepithelial lesion), and further testing reveals the presence of “high risk HPV types”. Three years before her PAP smear had been normal. You are now explaining the results to her. Which of the following statements is correct?

A. 70% of cervical cancers are associated with high risk HPV types
B. Untreated, she has a 90% chance of developing cancer
C. Persistence of HPV infection is the major risk factor for development of cervical cancer
D. HPV infection in her will probably not clear spontaneously
E. Use of the HPV vaccine can help her clear the infection.

C. Persistence of HPV infection is the major risk factor for development of cervical cancer

A 10-year-old girl is brought to her pediatrician after her mother found a bat in the room where she had been sleeping. Her physical exam is normal, including no evidence of a bite. This girl is now at risk for a disease that manifests primarily as:

A. Encephalitis
B. Myocardits
C. Flaccid paralysis
D. Hepatitis
E. Shock

What is the disease

A. encephalitis

the disease is rabies –> from bats, skunks, dogs

A 48 year-old man from Ohio presents with dry cough, fevers, and night sweats after working on a construction site. A chest radiograph reveals bilateral nodular infiltrates. Budding yeast are seen in sputum when stained with silver stain. The organism later grows in culture as a mold with tuberculate macroconidia. Which organism is most likely responsible for the symptoms?

A. Histoplasma capsulatum
B. Blastomyces dermatidis
C. Cryptococcus neoformans
D. Cocciodioides immitis
E. Candida albicans

A. Histoplasma capsulatum

tuberculate macronidia

A 72 year old couple goes for a drive through the lower Sonoran life zone in the Southwestern United States. A few years later the man is evaluated for what appears to be a lung tumor on chest radiography. On biopsy the pathologist is happy to report that she sees multiple yeast cells within a granuloma. She also notes a few large spherules discharging conidia. What organism is most likely responsible for the findings?

A. Histoplasma capsulatum
B. Blastomyces dermatidis
C. Cryptococcus neoformans
D. Cocciodioides immitis
E. Candida albicans

D. Cocciodioides immitis

What is side effect of amphotericin B?

renal failure

What is main side effect common to azoles [fluconazole, voriconazole, itraconazole]?

liver inflammation

When you hear tuberculate macronidia what should you think?

histoplasma capsulatum

What would you use to treat a pt with cryptococcal meningitis?

amphotericin or fluconazole

Can you use echinochandins [capsofungin] to treat cryptococcus?

no – it is resistant

A 44 year old man with advanced AIDS presents with fevers, chronic headaches, and mild photophobia. On physical exam he has mild neck stiffness and his laboratory values reveal a CD4 count of 27 (normal >500). His CSF examination reveals budding yeast cells that have a halo appearance when counterstained with India Ink. Over the course of his treatment he develops renal failure. What medication caused his renal failure?

A. fluconazole
B. amphotericin B
C. itraconazole
D. voriconazole
E. caspofungin

B. amphotericin B

A 65 year old heart transplant recipient from Bangladesh presents with abdominal pain and cough 6 months after transplant. His respiratory status declines and he is intubated. Blood cultures grow Klebsiella pneumoniae, Enterococcus, and Bacteroides fragilis. Microscopic examination of the sputum reveals a motile nematode. How did this parasite originally enter the host? What is it

A. via ingestion of eggs in contaminated drinking water
B. via ingestion of cysts when eating undercooked pork
C. via penetration of intact skin when he was walking barefoot in rural Bangladesh
D. via a mosquito vector that bit him in rural Bangladesh
E. via the bite of the sandfly vector

C. via penetration of intact skin when he was walking barefoot in rural Bangladesh

this is strongyloides

A 12 year old girl in rural Bolivia presents with poor school performance, delayed growth, and iron deficiency anemia. A nematode egg is found in her stool. Which parasite is the most likely cause of her symptoms?

A. Schistosoma hematobium
B. Schistosoma mansoni
C. Enterobius vermicularis
D. Necatur americanus
E. Taenia solium

D. Necatur americanus

hookworm!

What are the two most common groups of molds in pts with prolonged neutropenia?

aspergillus

- mucormycosis [rhizopus]

Can yeasts grow hyphae?

nope! just molds

A public health student is developing a project in rural Tanzania to decrease the rate of schistosomiasis in a small village. Which intervention would be expected to be most useful?

A. providing footwear for children walking in the warm moist soil around the farms
B. providing insecticide-treated bed nets for the population to sleep under
C. providing clean drinking water to the local population
D. providing special irrigation techniques to decrease the local snail population
E. controlling the disease in the local dog population

D. providing special irrigation techniques to decrease the local snail population

How is leishmaniasis acquired?

via sandfly vector

How is ascaris acquired?

eggs ingested via contaminated plant material or drinking water

How is strongyloides transmitted?

penetrating intact skin [usually via soil, walking barefoot]

What is distinctive of schistosoma hematobium egg?

terminal spine

What should you think: egg with lateral spine?

schistosoma mansoni

How is shistosomiasis transmitted?

penetration of cercariae across intact skin [relies on snail intermediate]

What are the 3 parasites that penetrate intact skin?

hookworm [necatur americanus, ancylostoma duodenale]
strongyloides
schistosomes

A 35-year-old woman gives birth prematurely to an infant who is found to be small for gestational age, with macrocephaly and hepatosplenomegaly. Evidence of retinitis is observed on fundoscopic exam. A head CT reveals the presence of very enlarged ventricles and intracranial calcifications. A review of the maternal history reveals that the mother had been vaccinated against rubella and had positive IgG against this virus during prenatal care. A urine culture for CMV on the infant is negative. How did this woman acquired the infection most likely responsible for this patient’s symptoms?

A. Saliva from an infected person
B. Mosquito bite
C. Exposure to cat feces
D. Walking barefoot
E. Sexual contact

C. Exposure to cat feces

What should you think: HIV, shortness of breath, hypoxemia, diffuse infiltrates and a BAL with trophic and cyst forms?

PCP pneumonia

A 3-year-old girl who received a heart transplant in her first year of life do to acute myocarditis of unkown etiology presents now with fever for 3 days. On review of systems her parents report that for the past 2 weeks she has been snoring at night and that her voice sounds muffled. Her chronic medications to prevent rejection include prednisone and tacrolimus. Her physical exam is significant for a temperature of 38.7, very enlarged tonsils which touch in the midline, and enlarged lymph nodes in the neck, axilla and groin bilaterally. An EBV PCR in serum shows 3,500 copies/105 peripheral blood lymphocytes. The patient undergoes a tonsillectomy and the pathology results shows polymorphic lymphocytic proliferation. There is no evidence of malignancy but the tissue stains positive for EBV early RNA (EBER). Which of the following interventions is most likely to be effective to prevent further EBV related complications?

A. acyclovir
B. cidofovir
C. ganciclovir
D. radiation therapy
E. reduction of immunosuppression

E. reduction of immunosuppression

14-year-old boy who was recently diagnosed with acute mylogenous leukemia is currently receiving induction chemotherapy. As a result he has been neutropenic for the past 11 days. 7 days ago he became febrile and since then he has been on Cefepime and Vancomycin. All his blood cultures have been negative. Today he developed cough and shortness of breath. A CT scan was performed which demonstrated bilateral nodular infiltrates. Which of the following agents would be most indicated at this point?
What does he likely have?

A. acyclovir
B. azithromycin
C. fluconazole
D. gancyclovir
E. voriconazole

E. voriconazole

He likely has invasve aspergillosis

A 24 year old ecologist returns from working in the jungles of Peru with a 2 cm cutaneous ulcer on her left lower leg. It is painless and has a slightly raised border and has developed over the course of several weeks. There is inflammation in the center of the ulcer, but she denies any fevers, chills, weight loss or other systemic symptoms. What is the most likely cause of this skin finding?

A. Toxoplasma gondii
B. Leishmania brasiliensis
C. Toxocara canis
D. Trypanosoma brucei rhodesiense
E. Wucheraria bancrofti

B. Leishmania brasiliensis

A 28 year old medical resident completes a 6 week long a global health project in rural Uganda in September. While there she was taking oral atovaquone/proguanil as prophyaxis. She feels well until January when she begins experiencing fevers, chills, and nights sweats every 48 hours. In between episodes she is able to continue her work in the Emergency Room. Finally she has a paroxysm of fever to 104 and shaking chills while on her night shift. A peripheral blood smear reveals intracellular rings. The infected cells are enlarged compared to the non-infected cells. Erythrocytic schizonts and gametocytes are visible on the peripheral blood smear. The organism is identified as Plasmodium ovale. In addition to treatment for the blood form of this parasite a medication used to treat the hypnozoite form is necessary. Which is the medication used to treat the hypnozoite form and which condition must be screened for when using this medication?

A. mefloquine, thalassemia
B. chloroquine, prolonged QT syndrome
C. primaquine, G6PD deficiency
D. doxycycline, sickle cell anemia
E. quinine, duffy antigen positivity

C. primaquine, G6PD deficiency

What are symptoms of toxocara canis?

visceral larva migrans

ocular larva migrans

How is toxocara canis transmitted?

zoonotic nemotode, transmitted when eggs ingested when children exposed to cat or dog feces

What is treatment for invasive pulmonary aspergillosis?

voriconazole

What syndrome do you need to check for before giving quinidine?

prolonged QT syndrome

A 65 year old man from Bangladesh receives a kidney transplant for chronic renal failure associated with hypertension and diabetes. Four months after the transplant he develops abdominal pain, cough, shortness of breath, shaking chills, and is admitted to the hospital. A CT scan reveals dilated loops of bowel and bilateral interstitial infiltrates. Blood cultures are positive for Klebsiella pneumoniae, E. coli, and Enterococcus faecalis. On microscopic examination of the sputum, motile larvae are visible. In addition to broad spectrum antibacterial agents, which of the following medications should be started?

A. ivermectin
B. praziquantel
C. quinine
D. mefloquine
E. liposomal amphotericin B

What clinical syndrome does he likely have?

A. ivermectin

he has strongyloides stercoralis hyperinfection syndrome

What is strongyloides hyperinfection syndrome?

you can have strongyloides for a long time [autoinfection cycle via perianal skin], when you have some sort of immunosuppression [transplant, HIV, etc] it can then rise up and cause a bacteremia

A 36 year old woman from Ecuador presents with new onset seizures and frontal headaches. A CT scan reveals several calcified nodules in the brain parenchyma as well as several fluid cysts. A scolex is visible in some of the cysts. What is the most likely source of the infection causing her symptoms?

A. Walking barefoot on a beach contaminated with the larvae of Ancylostoma braziliense
B. Swimming in a fresh water lake containing the cercariae of Schistosoma mansoni
C. Walking barefoot in an agricultural field contaminated with the larvae of Ancylostoma duodenale
D. The bite of an anopheles mosquito infected with Plasmodium malariae
E. Fecal contamination of her food by a person infected with Taenia solium

What does she have?

E. Fecal contamination of her food by a person infected with Taenia solium

she has neurocysticercosis

What is treatment for neurocysticercosis

albendazole or praziquantel

(+ steroids)

What is clinical manifestation of Ancylostoma braziliense?

= zoonotic hookworm –> cutaneous larva migrans or creeping eruptions

What is trditional presentation of S. mansoni?

portal hypertension, liver scarring

A 44 year old man from Bolivia presents with several months of shortness of breath, easy fatigue and palpitations. Transthoracic echocardiogram reveals dilation of the heart with a reduced ejection fraction of 20%. A transjugular myocardial biopsy reveals nests of amastigotes within the heart tissue. Which organism is most likely responsible for his symptoms?

A. Taenia saginata
B. Trypanosoma cruzi
C. Trypanosoma brucei rhodesiense
D. Trypanosoma brucei gambiense
E. Giardia lamblia

What disease does he have?

B. Trypanosoma cruzi

he has chagas disease

What body system are taenia saginata infections usually associated with?

GI tract

What is treatment for Hep B?

pegalated interferon alpha + NRTI [best is tenofovir]

What is treatment for Hep C genotype 1?

ribavirin + pegIFN + PI

PI = boceprevir or telaprivir

What is side effect of ribavirin

severe teratogen!!

What 2 things is ribavirin used to treat?

chronic HCV

RSV

How is rotavirus spread?

fecal oral –> shed pre and post infection

What is treatment for rotavirus?

oral rehydration/supportive

What is function of HA?

binds sialic acid = attachment

What is function of NA?

cleaves HA-sialic acid bond = allows spread

What is side effect of amantadine?

ataxia, dizziness, slurred speech = crosses BBB

What is treatment for RSV?

supportive, or if very serious

–> ribavirin

How is RSV transmitted?

fomites, secretions

What is struct of herpes viruses?

large enveloped dsDNA, linear, icosahedral capsule

What is treatment for HSV?

acylcovir or valacyclovir

What is treatment for VZV?

acylcovir or valacyclovir

What is treament for CMV?

ganciclovir or valganciclovir

if resistant: foscarnet, cidofovir

What is acyclovir/valacyclovir used to treat?

HSV1, HSV2, VZV

What is side effect of acyclovir?

renal tox –> prevent with hydration

What is mech of acyclovir?

requires phosphorylation by viral tK

- inhibits DNA pol –> chain termination

What is side effect of ganciclovir?

bone marrow suppression

What is mech of ganciclovir?

phosphorylated by viral kinase UL97 [CMV], viral DNA pol [UL54] incorporated it into chain –> chain termination

What is ganciclovir used to treat?

CMV

What is foscarnet used to treat?

when resistance to first line: HSV1, HSV2, VZV, CMV

What is cidofovir used to treat?

CMV when there is resistance

adenovirus in immune compromised

What is side effect of cidofovir?

nephrotoxicity [need to give with probenecid]

What is side effect of foscarnet?

nephrotoxicity
hypo or hypercalcemia
hyp or hyper phosphatemia

How are foscarnet and cidofovir administered?

IV only

What is an advantage of foscarnet/cidofovir?

do not require phosphorylation by viral enzymes

What is mech of foscarnet and cidofovir?

inhibit viral DNA pol

What do you do with pregnant woman with chickenpox?

acyclovir

What is this: fever and rash, maculopapular with crops of vesicles on erythematous base, some already starting to crust over, primarily face and chest?

chickenpox! [vzv]

What are the 3 things that can be transmitted intrapartum [during birth]?

HIV1
GBS
HSV

What are the two things that can be trasnsmitted in breast milk?

CMV

HIV1

How is parvoB19 transmitted vertically?

placentally

How is VZV transmitted vertically?

placentally

In HIV: white plaques on lateral tongue border than can’t be scraped off?

EBV oral hairy leukoplakia

How do you treat oral thrush [candidiasis]?

fluconazole or amphotericin

When do you expect toxo in HIV?

CD4 < 100

What is prophylaxis for toxo encephalitis in HIV? treatment if they already have it?

prophylaxis: TMP/SMX
treat: pyrimethamine + sulfadiazine

What 2 drugs are primarily used for toxo treatment? mech?

pyrimethamine and sulfadiazine

both inhibit folate synthesis

Side effect of zidovudine?

anemia, neutropenia

Side effect of emtricitabine?

hyperpigmentation of palms and soles

What is side effect nevirapine?

liver tox and rash in women with high CD4

When do you give MAC prophylaxis?

CD4 < 50 give azithromycin

Cup shaped fungi in HIV what should you think?

PCP

What is treatment for candida?

fluconazole
amphotericin
echinocandins [capsofungin]

What is treatment for aspergillus?

voriconazole = drug of choice for invasive
or amphotericin
immune reconstitution

What is treatment for zygomycetes?

surgical debridement
plus amphotericin or posaconazole

posaconazole = drug of choice for zygomycetes

What is treatment for cryptococcus?

amphotericine +/- 5FC

or Fluconazole

What is treatment for PCP?

TMP-SMX

What are the 3 things you should check for in HIV with CD < 100?

CNS toxoplasma
esophagitis candidia
cryptococcal meningitis

What are the 2 things you should check for in HIV <50?

disseminated mycobacterium avium complex

- CMV retinitis

AIDS pt from tropical asia what should you think?

penicillium

What is treatment for histoplasma?

amphotericin

itraconazole = drug of choice for invasive form

voriconazole

What is treatment for blastomyces?

amphotericin B
itraconazole
fluconazole

What is treatment for coccidiodes?

amphotericin B (+ fluconazole if immune compromised)

What is treatmetn for paracoccidioides?

itraconazole
amphotericine B
TMP-SMX

What is treatment for penicillium?

amphotericin + 5FC

What is mech of action of azoles?

target fungal cell membrane –> inhibit production ergosterol

Are azoles fungistatic or fungicidal?

generally fungistatic

What are topical azoles used for?

mucocutaneous candidiasis and dermatophyte infections

What is fluconazole used to treat?

candida albicans
cryptococcal meningitis
NOT: aspergillus, mucor.

Does fluconazole penetrate CSF?

yep

What is itraconazole used to treat?

azole of choice for: invasive histoplasma, blastomyces, sporothrix
can use to treat: candida albicans, aspergillus, dermatophytes/onchychomycosis if topicals don’t work

Does itraconazole penetrate CSF?

What is voriconazole used to treat?

drug of choice for: invasive aspergillosis

can also treat: candida, aspergillus, fusarium
not: zygomycetes

What is possible side effect of voriconazole?

visual disturbances

What is possible side effect of posaconazole?

prolonged QTc when give with quinidine

How is posaconazole administered?

oral – NO IV

Can voriconazole and posaconazole penetrate CSF?

YEP!

What is the only azole we talked about that doesnt penetrate CSF well?

itraconazole

What is amphotericin used to treat?

drug of choice for: cryptococcal meningitis, zygomycetes, disseminated histoplasma,
good for invasive aspergillosis

Does amphotericin cross BBB?

NOPE –> need to give intrathecally for fungal meningitis

What is toxicity associated with amphotericin?

infusinon related

renal toxicity [partially irreversible]

Are echinocandins fungistatic or fungicidal against aspergillus/candida?

fungistatic against aspergillus

fungicidal against candida

What is clinical use of echinocandins?

aspergillus
candida
NOT: cryptococcus, fusarium, zygomycetes

What is mech of action terbinafine?

interferes with ergosterol synthesis

What is terbinafine used to treat?

oral med for onychomycosis [nail fungus]

What is nystatis used to treat?

mucocutaneous candidiasis

What is mech of echinocandins?

inhibit beta D glucan synthesis

What is mech of amphotericin/nystatin?

makes pores in cell membrane

What should you think: rural hondura, kid with N/V, fallen off growth curve, abdomen distened, mildly jaundiced, eggs in stool?

ascaris lumbricoides

What is treatment for ascaris lumbricoides?

mebendazole or albendazole

What is mech of action benzimidazoles?

immobilize and kill worms, inhibit assembly microtubules and glucose uptake

What do you treat strongyloides?

albendazole PLUS ivermectin

How do you treat hookworm?

mebendazole or albendazole + IRON

How do you treat all intestinal nematodes?

[ascaris, necatur/ancylostoma, strongyloides, enterobius, trichurius, toxocara]

mebednazole or albendazole

PLUS IVERMECTIN FOR STRONGYLOIDES

Hoq do you treat trichinella?

mebendazole and steroids

How do you treat drancunculus?

slowly extract worm mechanically

How do you treat onchocerca?

ivermectin

How do you treat wuchereria?

diethylcarbamazine

What are the 5 systemic dimorphic endemic fungi [mold in culture, yeast in body]?

histoplasma
coccidioides
blastomyces
paracoccidioides
penicillium

Main treatment for candida?

fluconazole

what is it: India ink showed capsules on CSF

cryptococcal meningitis

What is diagnostic for cryptococcus neoformans?

cryptococcal capsular antigen in blood or CSF

what is treatment for cryptococcus neoformans?

amphotericine + f-fluorouracial [5FC]

or fluconazole

How do you diagnose histoplasma?

urine antigen

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