VIRAL INFECTIONS (based on Williams)

Question 1

What is a major cause of maternal and fetal morbidity and mortality worldwide?

Answer 1

Infections.

Question 2

How does the maternal-fetal vascular interface affect infections?

Answer 2

It can either protect the fetus or serve as a conduit for transmission.

Question 3

What factors influence disease outcome in maternal infections?

Answer 3

Maternal serological status. acquisition mode.gestational age at infection and immunological status of mother and fetus.

Question 4

What does the TORCH acronym stand for?

Answer 4

Toxoplasmosis. Others. Rubella.Cytomegalovirus and Herpesvirus infections.

Question 5

What is the primary function of regulatory T cells (Tregs) during pregnancy?

Answer 5

They induce maternal immune tolerance to the fetus by expressing FOXP3.

Question 6

How does pregnancy affect maternal defense against bacterial pathogens?

Answer 6

The immune tolerance mechanisms compromise maternal defense against bacterial infections.

Question 7

What is horizontal transmission?

Answer 7

The spread of an infectious agent from one individual to another.

Question 8

What is vertical transmission?

Answer 8

Passage of an infectious agent from mother to fetus via placenta. during labor. delivery or breastfeeding.

Question 9

What is the secondary attack rate?

Answer 9

The probability that infection develops in a susceptible individual after contact with an infectious person.

Question 10

When does fetal innate and adaptive immunity begin to develop?

Answer 10

Between 9 to 15 weeks’ gestation.

Question 11

How is passive immunity provided to the fetus?

Answer 11

Through maternal immunoglobulin G (IgG) transfer across the placenta.

Question 12

What is the most common perinatal infection in the developed world?

Answer 12

Cytomegalovirus (CMV) infection.

Question 13

How is CMV transmitted?

Answer 13

Via body fluids such as saliva. semen. urine. blood and cervical secretions.

Question 14

What is the vertical transmission rate of CMV during pregnancy?

Answer 14

30-36% in the first trimester. 34-40% in the second and 40-72% in the third trimester.

Question 15

What is the gold standard for diagnosing fetal CMV infection?

Answer 15

CMV polymerase chain reaction (PCR) testing of amniotic fluid.

Question 16

What are common sonographic findings in fetal CMV infection?

Answer 16

Microcephaly. ventriculomegaly. cerebral calcifications. hepatosplenomegaly. ascites and hyperechoic bowel.

Question 17

What is symptomatic congenital CMV infection?

Answer 17

A syndrome including growth restriction. microcephaly. intracranial calcifications. chorioretinitis. mental/motor delays. hepatosplenomegaly and thrombocytopenic purpura.

Question 18

How is primary maternal CMV infection diagnosed?

Answer 18

By IgG seroconversion and low IgG avidity.

Question 19

What is the sensitivity of amniotic fluid PCR testing for CMV?

Answer 19

70-99%. depending on timing of amniocentesis.

Question 20

What is the management of pregnant women with primary CMV infection?

Answer 20

Symptomatic treatment; detailed fetal ultrasound; possible amniocentesis for diagnosis.

Question 21

What are the recommended preventive measures for CMV infection in pregnant women?

Answer 21

Hand washing. avoiding sharing food/utensils and limiting contact with saliva/urine of young children.

Question 22

Which infections can be transmitted transplacentally?

Answer 22

Varicella-zoster. rubella. CMV. HIV.Zika. SARS-CoV-2. syphilis. toxoplasmosis. malaria. and others.

Question 23

Which infections can be transmitted via ascending infection?

Answer 23

Group B Streptococcus (GBS). coliform bacteria. HIV.

Question 24

Which infections can be acquired intrapartum?

Answer 24

Gonorrhea. chlamydia. GBS. tuberculosis. HSV. HPV. HIV. hepatitis B/C. Zika.

Question 25

What is the main mode of transmission of neonatal CMV infection?

Answer 25

Intrapartum exposure or breastfeeding.

Question 26

How does congenital CMV affect twins differently?

Answer 26

Infections in dichorionic twins are most likely non-concordant.

Question 27

Why is routine prenatal CMV serological screening not recommended?

Answer 27

Because primary CMV infection is often asymptomatic and screening may not change management.

Question 28

What is the role of CMV-specific IgG avidity testing?

Answer 28

To distinguish between recent and past CMV infections.

Question 29

What is the most common neonatal clinical sign of congenital CMV infection?

Answer 29

Sensorineural hearing loss.

Question 30

What type of virus is Varicella-Zoster Virus (VZV)?

Answer 30

A double-stranded DNA herpesvirus.

Question 31

What is the primary mode of transmission of primary varicella (chickenpox)?

Answer 31

Respiratory droplets or direct contact with an infected individual.

Question 32

What is the incubation period of primary varicella?

Answer 32

10 to 21 days.

Question 33

What is the risk of infection after exposure to VZV in a non-immune woman?

Answer 33

70 to 90 percent.

Question 34

How long is a person with primary varicella contagious?

Answer 34

From 1 day before rash onset until all lesions become crusted.

Question 35

What is the most common cause of mortality in adult varicella infections?

Answer 35

Secondary infection or VZV pneumonia.

Question 36

What are the risk factors for severe VZV pneumonitis?

Answer 36

Immunosuppression and early bacterial co-infection.

Question 37

What are the symptoms of VZV pneumonia?

Answer 37

Fever. tachypnea. dry cough. dyspnea and pleuritic pain.

Question 38

What is the characteristic radiographic finding of VZV pneumonia?

Answer 38

Nodular infiltrates similar to other viral pneumonias.

Question 39

What causes herpes zoster (shingles)?

Answer 39

Reactivation of latent VZV years after primary infection.

Question 40

What is the characteristic feature of herpes zoster?

Answer 40

Unilateral dermatomal vesicular eruption often with severe pain.

Question 41

Is herpes zoster more frequent or severe in pregnancy?

Answer 41

No. zoster is not more frequent or severe in gravidas.

Question 42

What are the features of congenital varicella syndrome?

Answer 42

Chorioretinitis. microphthalmia. cerebral cortical atrophy. growth restriction. hydronephrosis. limb hypoplasia. cicatricial skin lesions.

Question 43

What is the highest risk period for congenital varicella syndrome?

Answer 43

Between 13 and 20 weeks of gestation.

Question 44

What is the risk of congenital varicella syndrome if maternal varicella occurs before 13 weeks?

Answer 44

0.4 percent.

Question 45

What is the neonatal attack rate if exposed to maternal varicella just before or during delivery?

Answer 45

25 to 50 percent.

Question 46

What is the neonatal mortality rate in severe perinatal varicella?

Answer 46

Approaches 30 percent.

Question 47

What is the recommended treatment for neonates exposed to maternal varicella?

Answer 47

Varicella-zoster immune globulin (VariZIG).

Question 48

When should VariZIG be given to neonates?

Answer 48

If maternal varicella occurs 5 days before or up to 2 days after delivery.

Question 49

What is the best diagnostic test for active maternal varicella infection?

Answer 49

PCR-based testing of vesicular fluid or crusted lesions.

Question 50

What is the role of PCR-based testing of amniotic fluid in congenital varicella?

Answer 50

A positive result does not correlate well with congenital infection development.

Question 51

What imaging modality may be used to evaluate for congenital varicella syndrome?

Answer 51

Detailed anatomical sonographic evaluation at least 5 weeks after maternal infection.

Question 52

What is the recommended serological test for varicella exposure in pregnancy?

Answer 52

VZV IgG serology.

Question 53

What is the recommended prophylaxis for seronegative pregnant women exposed to varicella?

Answer 53

Intramuscular VariZIG. 125 units per 10 kg body weight (max 625 units).

Question 54

How long after varicella exposure can VariZIG be given?

Answer 54

Up to 10 days.

Question 55

What is the recommended antiviral treatment for severe maternal varicella?

Answer 55

Intravenous acyclovir 10–15 mg/kg every 8 hours until afebrile.

Question 56

What is the recommended treatment for uncomplicated primary varicella in pregnancy?

Answer 56

Oral acyclovir. 800 mg five times daily for 7 days.

Question 57

Is varicella vaccination recommended in pregnancy?

Answer 57

No. it is a live attenuated virus vaccine and contraindicated in pregnancy.

Question 58

Can breastfeeding women receive varicella vaccination?

Answer 58

Yes. because the vaccine virus is not secreted in breast milk.

Question 59

What family of viruses does Influenza A and B belong to?

Answer 59

Orthomyxoviridae.

Question 60

What are the two surface antigens used to classify Influenza A viruses?

Answer 60

Hemagglutinin (H) and neuraminidase (N).

Question 61

What are the characteristic symptoms of influenza infection?

Answer 61

Fever. dry cough. systemic symptoms.

Question 62

What are the severe complications of influenza in pregnancy?

Answer 62

Pulmonary involvement. hospitalization. increased mortality.

Question 63

What is the recommended antiviral treatment for influenza in pregnancy?

Answer 63

Oral oseltamivir 75 mg twice daily for 5 days.

Question 64

What is the recommended chemoprophylaxis for pregnant women exposed to influenza?

Answer 64

Oral oseltamivir 75 mg once daily for 7 days.

Question 65

When should influenza vaccination be given during pregnancy?

Answer 65

Anytime during influenza season. ideally before the end of October.

Question 66

Is live attenuated influenza vaccine recommended in pregnancy?

Answer 66

No. only inactivated or recombinant vaccines are recommended.

Question 67

What type of virus is SARS-CoV-2?

Answer 67

Single-stranded RNA coronavirus.

Question 68

What is the primary mode of transmission of SARS-CoV-2?

Answer 68

Respiratory droplets.

Question 69

What is the incubation period of COVID-19?

Answer 69

Approximately 5 to 14 days.

Question 70

What are the most common symptoms of COVID-19?

Answer 70

Fever. cough. myalgia. anosmia. ageusia.

Question 71

What are the risk factors for severe COVID-19 in pregnancy?

Answer 71

Diabetes. obesity. hypertension. advanced maternal age.

Question 72

How does severe COVID-19 in pregnancy present radiographically?

Answer 72

Multifocal ground-glass opacities and peripheral consolidations on CT scan.

Question 73

Is vertical transmission of SARS-CoV-2 common?

Answer 73

No, it is rare.

Question 74

What is the recommended treatment for severe COVID-19 in pregnancy?

Answer 74

Oxygen therapy. dexamethasone. remdesivir. supportive care.

Question 75

What is the role of dexamethasone in severe COVID-19?

Answer 75

Reduces mortality in patients requiring supplemental oxygen or mechanical ventilation.

Question 76

What is the role of remdesivir in COVID-19?

Answer 76

Shortens recovery time in hospitalized patients with low-flow oxygen needs.

Question 77

What is the best way to prevent SARS-CoV-2 transmission?

Answer 77

Masking.physical distancing. hand hygiene.

Question 78

Are COVID-19 vaccines recommended in pregnancy?

Answer 78

Yes. they are safe and protective against severe disease.