Viral infections and Tx, The Kinders, CIS

Question 1

50 y.o 1 day Hx fever, weakness and body aches
normal WBC
preemptive Dx

Answer 1

flu

Question 2

Tx for influenza A and prophylaxis

Answer 2

oseltamivir

Question 3

What are amantidine and rimantidine

Answer 3

M2 Ch blockers for Tx influenza A only

Question 4

how oseltamivir works

Answer 4

blocks release of new influenza A and B virions

Question 5

how does rimantadine and amantadine work

Answer 5

prevents penetration of influenza A (not B) virus into the host cell

Question 6

when do you initiate anti-viral therapy

Answer 6

within 48 hrs of Sx

Question 7

caution should be uses with which antiviral in patients with COPD or asthma

Answer 7

zanamivir because bronchospasm

Question 8

side effect of oseltamivir

Answer 8

diarrhea, psychiatric behavior changes

Question 9

3 mo ED with fever, difficulty feeding and thick nasal discharge
baby stops breathing when feeding
winter season
most likely infection?

Answer 9

RSV

Question 10

Tx RSV

Answer 10

supportive care

pharmacotherapy: bronchodilators, hypertonic saline, ribavirin

Question 11

what is ribavirin MOA

Answer 11

nucleoside analog that inhibits replication RNA and DNA viruses
inhibits viral protein synthesis

Question 12

ribavirin is reserved for what and why

Answer 12

life threatening disease because may be toxic

Question 13

what is palivizumab and use

Answer 13

monoclonal Ab for prophylaxis of RSV

inhibits RSV replication

Question 14

52 y.o M
DM with recent kidney transplant
on tacrolimus, mycophenolate, prednisome
bactrim, valganciclovir
what is bactrim used prophylactically for?

Answer 14

PCP prophylaxis

Question 15

bactrim prophylaxis regimen after transplant

Answer 15

6 mo-1 yr

Question 16

alternative prophylaxis for PCP if sulfa allergy

Answer 16

atovaquone
dapsone
inhaled pentamidine

Question 17

which CMV prophylactic has greater bioavailability

Answer 17

valganciclovir

Question 18

33 y.o M painful rash on back and chest
pain burning and tingling 2-3 days prior
Dx?

Answer 18

varicella zoster

Question 19

how is varicella zoster spread

Answer 19

respiratory droplets

exposure as child

Question 20

how is varicella zoster prevented in adults

Answer 20

varicella zoster vaccine that is given to adults>60

live attenuated

Question 21

contraindications for varicella zoster vaccine

Answer 21

immunocompromised
CD4<200
immunosuppressive therapy
TNF alpha therapy

Question 22

why is acyclovir virus specific

Answer 22

virus specific initial viral step

thymidine kinase

Question 23

major limitation of acyclovir

Answer 23

low bioavailability, up to 5x a day

Question 24

9 y.o M 
fever cough and dyspnea
rash on face that spreads down
high fever, tachycardia and tachypnea
red spots with blue white centers

Answer 24

kopilik spots

rubeola- measles

Question 25

how is measles spread

Answer 25

respiratory droplets

Question 26

3 Cs in measles

Answer 26

cough, coryza(nose inflammation) and conjunctivitis

Question 27

how long is child with measles infectious

Answer 27

8 days | 4 days before and 4 days with onset

Question 28

complications of measles

Answer 28

diarrhea, otitis media and pneumonia | encephalomyelitis and sclerosing panencephalitis

Question 29

prognosis of subacute sclerosing panencephalitis

Answer 29

fatal

Question 30

how is measles prevented

Answer 30

mmr

Question 31

signs postinfectious encephalomyelitis

Answer 31

2 weeks after rash | onset HA, fever, vomiting, stiff neck

Question 32

16 y.o M with fever HA malaise, facial swelling 3 days testicular pain unknown vaccination status

Answer 32

mumps

Question 33

clinical manifestations of mumpms

Answer 33

parotitis aseptic meningitis encephalitis rare and severe orchitis

Question 34

how is mumps spread

Answer 34

respiratory droplets

Question 35

Tx mumps

Answer 35

supportive

Question 36

55 y.o M fever, chills, myalgias HA no edema, lungs CTA, heart RRR

Answer 36

viral or bacterial

Question 37

elevated PT and PTT is characteristic

Answer 37

DIC

Question 38

``` 4 y.o M severe dyspnea hypoxic 84% on RA expiratory wheezing b/l interstitial infiltrates Tx with albuterol but returns with LE paralysis, MRI shows anterior myelitis ```

Answer 38

polio boltulinum toxin guillain barre enterovirus D-68

Question 39

second most common cause of common cold

Answer 39

corona virus

Question 40

reservoir for SARS

Answer 40

birds and small mammals

Question 41

Dx SARS

Answer 41

clinical Hx and travel Hx | far east or Toronto

Question 42

clinical manigestations SARS

Answer 42

flu like | fever above 100.4

Question 43

Tx SARS

Answer 43

supportive

Question 44

what are shape paramyxoviruses

Answer 44

enveloped helical nucleocapsid | negative sense ssRNA

Question 45

shape CMV

Answer 45

ds DNA

Question 46

large central basophilic intranuclear inclusion "owl eye" is indicative of what

Answer 46

CMV

Question 47

Clinical manifestations of congenital and neonatal CMV

Answer 47

microcephaly, intracerebral calcification HSM and rash mental retardation and hearing loss

Question 48

how does CMV present in immunocompetent

Answer 48

asymptomatic | some have mono-like illness

Question 49

CMV in transplant recipient

Answer 49

fever, neutropenia, atypical lymphocytes and HSM hepatitis pneumonia colitis-diarrhea

Question 50

CMV in AIDS patients

Answer 50

CD4<50 retinitis colitis

Question 51

Dx CMV

Answer 51

culture, CMV Ag or nucelic acid detection | serology

Question 52

Prevention of CMV

Answer 52

reducing exposure to body fluids

Question 53

Tx RSV

Answer 53

ribavarin

Question 54

clnical manifestations of RSV

Answer 54

``` conjunctivat injection, mucous discharge from nose cough low grade fever otitis media lower resp Sx expiratory wheezing diffuse interstitial pneumonitis ```

Question 55

clinical presentation measles

Answer 55

incubate 8-12 days | flu like with koplik spots which proceed to maculopapular rash

Question 56

What does parainfluenza cause

Answer 56

croup bronchiolitis or pneumonia cold

Question 57

What are the paramyxoviruses

Answer 57

parainfluenza measles mumps RSV