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Clinical Medicine II > Viral Infections Part II > Flashcards

Viral Infections Part II Flashcards

1
Q

Where does the rabies virus infect?

A
  • Central Nervous system
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2
Q

What is the #1 cause of rabies in the US

A
  • Bat bites
#2 Raccoons 
#3 Skunks 
#4 Foxes
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3
Q

What are S&S that depict rabies?

A
  • Acute
  • Progressive to encephalomyelitis
  • Can’t be stopped
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4
Q

What is the incubation period of rabies?

A
  • Normally 10 to 90 days

- Rarely 7 years

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5
Q

T of F

Rabies symptoms are progressive?

A
  • True

Initially

  • Fever
  • Headache

Progresses to

  • Anxiety
  • Confusion
  • Agitation
  • Hypersalivation
  • Difficulty/Painful
    swallowing
  • Hydrophobia

Eventually

  • Death
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6
Q

How do you Dx Rabies?

A
  • CSF PCR
    Maybe negative early in disease
  • Skin Bx
  • MRI
    Maybe Grey matter involvement
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7
Q

Tx for Rabies?

A
  • Local wound cleansing & Debridement
  • Local and Distal Anti rabies Immunoglobulin
  • Systemic Vaccination
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8
Q

Who must receive Pre Exposure prophylaxis rabies vaccine?

A
  • Traveling to Africa

- Zoo Employees

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9
Q

T of F

CMV (Herpes) is a common infection in the US?

A
  • True

- Very common

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10
Q

Most pts with CMV infections are ?

A
  • Sub Clinical Asymptomatic

- Disease is Self limiting in a normal host

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11
Q

Who is at higher risk of CMV infections?

A
  • Elderly pt’s
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12
Q

When is CMV usually presenting with symptoms?

A
  • Immunocompromised Pt’s
  • Usually presents like Mononucleosis (EBV)
  • Severe CMV
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13
Q

How is CMV transmitted?

A

Acquired CMV

  • Sexual contact
  • Breast milk
  • Blood transfusion
  • Respiratory droplets
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14
Q

What are the the common S&S of CMV?

A
  • Resembles Mononucleosis (EBV)

- Without Pharyngitis or Respiratory symptoms

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15
Q

What are some EBV and CMV common S&S?

A
  • Fever
  • Malaise
  • Myalgias / Arthralgias
  • Enlarged Spleen
  • Abnormal spleen
  • Abnormal LFT
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16
Q

T of F

Perinatal CMV is common with infection mothers during pregnancy?

A
  • True 10%

- Infant maybe symptomatic at first

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17
Q

Clinical findings in an infant with CMV?

A
  • Jaundice
  • Hepatospleenomegly
  • Thrombocytopenia
  • Mitral Regurgitation
  • Motor disability
  • Purpura
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18
Q

Retinitis in an Immuno Compromised Pt’s with CMV will show?

A
  • “Pizza Pie” Neovascularization and Proliferative Macula lesions
  • (CD4 < 50)
  • Treat HIV control CMV
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19
Q

Immuno Compromised Pt’s with CMV will be at risk of?

A
  • Retinitis
  • GI symptoms
  • Pulmonary symptoms
  • Neurological symptoms
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20
Q

Dx of CMV includes?

A
  • PCR (CSF, Blood or Urine)
  • Will show CMV Antigens
  • Tissue Bx
  • Will show intracytoplasmic inclusions (Owl Eyes)
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21
Q

Tx of CMV in a healthy pt is required?

T of F

A
  • False

- Only Tx if Pt is in severe organ system disease

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22
Q

How do you prevent CMV?

A
  • Limit blood transfusion (filtering to remove leukocytes)

- Restricting the organ donor pools to seronegative donors

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23
Q

Tx of pts with severe organ diseases with CMV includes?

A

Preferred Tx

  • Valacycylovir (PO)
  • Ganciclovir (IV)
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24
Q

HPV only infects humans with 200+ types of strains, what are the two sub-types?

A
  • Cutaneous

- Anogenital

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25
Q

What are the two HPV types associated with cancer?

A
  • HPV 16 and 18
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26
Q

What are the most common two types of HPV associated with Cutaneous genital warts (Condyloma acuminatum)

A
  • HPV 6 & 11

- 90% of Genital warts (20 & 24y/o)

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27
Q

What are the HPV strains that causes regular skin warts?

A
  • HPV 1, 2, 3, 4, 10

- Common in kids

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28
Q

T or F

HPV can cause Anal and Oropharyngeal cancer?

A
  • True
  • Anal (W>M)
  • Oral (Tongue and Oralpharynx)
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29
Q

T or F

HPV can causes Cervial, Vulvar and Vaginal cancer?

A
  • True
  • Cervical common 4th leading cause
  • Vulvar and Vaginal
    uncommon
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30
Q

How do you detect HPV?

A
  • Cervical and Oral Bx
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31
Q

How many vaccines are there for HPV?

A
  • 3 vaccines

- All 3 with Direct benefit for M and W against cancer

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32
Q

HPV 9 Valent vaccine (Gardasil 9) protects against?

A
  • HPV types 6,11,16,18,31,33,45,52,58
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33
Q

HPV Quadravalent vaccine (Gardasil) protects against ?

A
  • HPV types 6,11,16 & 18
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34
Q

HPV Bivalent vaccine (Cervarix) protects against ?

A
  • HPV types 16 & 18
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35
Q

What is the age range and doses for the HPV vaccines?

A
  • 3 Doses M and F
  • As early as 9 y/o
  • As late as 26 y/o
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36
Q

What is a major concern wit HPV and pregnancy?

A
  • Juvenile laryngeal papillomatosis
  • Debilitating disease in children
  • Maternal - Fetus transmission unknown
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37
Q

Tx of HPV in a pregnant mother?

A

Small genital disease:
- Tirchloroacetic acid

Large genital disease:
- Carbon dioxide laser

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38
Q

What is the deadliest month of the Flu in american history?

A
  • October 1918

- 195k deaths

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39
Q

Who is at higher risk with influenza?

A
  • Kids < 5
  • Elderly > 65
  • Pregnancy (3rd Trimester)
  • Chronic diseases
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40
Q

What can be a complication of the flu?

A
  • Viral lung issues (Infiltrate everywhere)
  • Weakens lungs
  • Causes Bacterial Pneumonia (Infiltrate concentrated)
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41
Q

The flu A or B is ?

A
  • Acutely debilitating
  • Self limiting
  • Winter months
42
Q

Incubation period of the Flu?

A
  • 1 to 4 days

- 2 days average

43
Q

What happens after the incubation period of the flu?

A
  • Abrupt onset
  • Fever (100 - 106)
  • Headache
  • Malgias
  • Arthralgias
  • Weakness
44
Q

What respiratory symptoms are associated with the flu?

A
  • Non productive cough
  • Sore throat
  • Nasal discharge
45
Q

T of F

GI symptoms with the Flu are common in kids?

46
Q

When can pt’s start feeling better from the Flu?

A
  • Improvement in 2 to 5 days
47
Q

What are PE findings associated with the Flu?

A
  • Diminished breath sounds

+/- wheezing

  • Flushed face
  • Conjunctival redness (Red Eyes)
48
Q

When can Flu viral shedding occur?

A
  • 24 to 48 hours before the onset of symptoms
49
Q

When is the rapid flu test used and on who?

A
  • Adults with area known to have influenza (Nasopharynx)

- Detects A and B flu strains

50
Q

When does the rapid influenza test provide the highest sensitivity?

A
  • Early viral shedding stages (24 to 48 hours before symptoms)
  • 50 to 70% sensitivity
  • 10 results
51
Q

T of F

Labs are helpful for Flu dx?

52
Q

What is the gold standard for influenza Dx?

A
  • Viral PCR
  • 98% Sensitivity
  • 1-2 day turn around
53
Q

Can the Rapid Influenza Test provide false negatives with a flu swab?

T of F

A
  • True

- Institution specific

54
Q

What is the antiviral DOC for the flu A & B?

A
  • Oseltamivir
    (Tamiflu) (pill & liquid)
  • Nausea and Vomiting
55
Q

What are other options for antiviral’s for the flu A & B?

A
  • Zanamivir
    (Relenza inhaler)
  • Severe bronchospasm in pts with underlying ling Dz
  • Peramivir
    (Rapivab IV)
  • Nausea & Diarrhea
56
Q

What antivirals should not be used in the US (Resistance to A influenza issues) ?

A
  • Amantadine

- Rimantadine

57
Q

When must antivirals be started by to be effective?

A
  • 24 to 48 hours

- Shortens course of illness by 1/2 to 3 days

58
Q

What are prevention strategies for the Flu?

A
  • Flu vaccine
  • Hand washing
  • Respiratory hygiene
  • Avoid crowded areas during peak flu season (Winter)
59
Q

If you get a negative with a rapid test but still suspect the flu should you consider antivirals?

A
  • Yes
  • Consider Tx because the test could be wrong
  • False negative
60
Q

What is the minimum age recommendation for the flu vaccine if no contraindications?

A
  • 6 + months
61
Q

T of F

The Zika virus my cause no symptoms or only mild symptoms?

62
Q

T or F

There is no local transmission of Zika in the US?

63
Q

What are the major concerns with the Zika virus?

A

1) Congenital effects (10% High risk) Birth defects

2) Perinatal effects

64
Q

What are the congenital effects of the Zika virus?

A
  • Micorcephaly
  • Decreased brain tissue
  • Contractures
  • Macular scarring
  • Seizures
65
Q

What are the major Perinatal effects with the Zika Virus?

A
  • Maculopapular rash
  • Conjunctivitis
  • Arthralgia
  • Fever
66
Q

Where is the highest incidence rate of HIV (Epidemic) 30+ Million world wide?

67
Q

How is HIV transmitted?

A
  • Bodily fluids
68
Q

T of F

Needle sticks in the hospital have a high rate of HIV transmission?

69
Q

How does an HIV pt present at first?

A
  • Mononucleosis like syndrome
  • Constellation of non specific symptoms
  • Can be missed if not suspected
70
Q

How long from the time of exposure do HIV pt’s usually develop symptoms?

A
  • 2 to 4 weeks from inoculation

- 10% to 60% are asymptomatic

71
Q

What are the most common S&S of an acute HIV pt?

A
  • Fever, Fatigue, Myalgias (MOST COMMON)
  • Lymphadenopathy (Axillary, Cervical, Occipital)
  • Sore Throat
72
Q

HIV acute pts usually have a sore throat with?

Hallmark Sign

A
  • Painful mucocutaneous ulcerations (Oral Ulcers)

- Most distinctive manifestations of HIV disease

73
Q

Other less common S&S of HIV?

A
  • Fever then Rash (Trunk Rash) last for 5 to 8 days
  • Diarrhea
  • Weight Loss
  • Headache
    (Retrobulbar worsened by eye movement)
74
Q

What would raise your suspicion for acute HIV infection?

A
  • Prolonged course (Weeks)

- Oral ulcers

75
Q

What is the screening method used for HIV?

A

1 ELISA

  • Enzyme Linked Immunosorbent assay (ELISA)
  • 50% positive within 22 days
  • 95% positive within 6 weeks

Confirm repeat study
#2 ELISA
+
#3 Western Blot

76
Q

What is the HIV rapid antibody test?

A
  • Easy, Quick Test (10Mins)

- If positive MUST confirm with ELISA & Western blot

77
Q

The western blot confirmation test is reliable early in the infection ?

T or F

A
  • False

- Not reliable

78
Q

What must you monitor during an HIV infection?

A
  • CD4 count
  • Indicated pt’s prognosis
  • Susceptibility to opportunistic infections
79
Q

What increases the risk HIV to AIDS opportunistic infections or Malignancy?

80
Q

What test monitors the HIV progression and response to antiretroviral medications?

A
  • Viral Load test

- May ping positive in acute HIV infection (Before Seroconversion)

81
Q

T or F

You must consider referral to an ID specialist for antiretroviral therapy?

A
  • True

- In acute HIV pt’s

82
Q

What increases the risk of opportunistic infections in an HIV pt?

A

1) Environment (TB endemic, Mycobacterium, SCC, Merkel Cells, Lymphomas)
2) Behavioral Factors (Drug use)
3) Demographics

83
Q

What does the HIV infection rely on for opportunist infections?

A

1) Environment

2) Behavioral

84
Q

What are some opportunist infections associated with HIV?

A
  • PCP
  • Toxoplasma encephalitis
  • CMV retinitis
  • Cryptococcal meningitis
  • Cryptosporidiosis
  • Microsporidiosis
  • Kaposi sarcoma
  • Squamous Cell carcinoma
  • Merkel Cell
  • Lymphomas
85
Q

What are the opportunistic infections associated with HIV and CD4 counts > 200

A

1) Bacterial infections
2) TB
3) Herpes Simplex
4) Herpes Zoster
5) Vaginal Candidasis
6) Hairy Leukoplakia (EBV)
7) Karposi Sarcoma

86
Q

What are the opportunistic infections associated with HIV and CD4 counts < 200

A

1) Pneumocystosis
2) Toxoplasmosis
3) Cryptococcosis
4) Cryptosporidiosis
5) Coccidioidomycosis

87
Q

What are the opportunistic infections associated with HIV and CD4 counts < 50

A

1) Disseminated MAC infection
2) Histoplasmosis
3) CNS Lymphoma
4) CMV Retinitis

88
Q

What does HIV care maintenance require?

A

Baseline

  • Genetic resistance testing
  • LFT
  • HA1C

3 - 6 months test

  • CD4 Counts
  • Viral loads
  • CBC, CMP, LFT
  • HA1C
89
Q

What vaccines must be up to date on HIV pt’s?

A

1) Pneumococcal
2) Meningococcal
3) Herpes zoster
4) Flu
5) Hep A and B
6) Tdap
7) HPV for females

90
Q

What prophylaxis’s treatment is done on HIV pts with < 200?

A
  • Pneumocystis jirovecii prophylaxis (trimethoprim-sulfmethoxazole)
91
Q

What prophylaxis’s treatment is done on HIV pts with < 75 ?

A
  • Mycobacterium avium prophylaxis (azithryomycin)
92
Q

What prophylaxis’s treatment is done on HIV pts with < 50 ?

A
  • CMV prophylaxis
93
Q

T or F

Pts being treated for HIV can develop metabolic syndrome due to medications?

94
Q

True - False

ID specialist are the specialist in charge of the multi drug regime for HIV pt’s

A
  • True

- Usually fixed doses (Vir Drugs) which simplify’s it

95
Q

Pre-Exposure prophylaxis treatments for HIV are offered to all pts?

T of F

A
  • False

- Only offered to high risk Pt’s

96
Q

What are the two Pre-Exposure prophylaxis HIV medications?

A

1) Tenofovir
2) Emtricitabine (Truvada)
- Might be covered by Ins
- $1700 a month

97
Q

What are the Post exposure policies for HIV prophylaxis ?

A
  • Exposure type

and

  • HIV status of pt
98
Q

What is the goal for Post Exposure HIV prophylaxis treatment?

A
  • Within 1 to 2 hours of exposure

- Not effective after 72 hours

99
Q

The type of exposure of HIV correlates to the risk of sero conversion, what increases the risk?

A
  • Deep injury
  • Device visibly contaminated with blood
  • Source patient with high viral load
100
Q

What are the 3 medications used for Post Exposure HIV prophylaxis treatment?

A
  • Tenofovir + Emtricitabine + Raltegravir
101
Q

What bodily fluids MIGHT transfer HIV?

A

1) CSF
2) Synovial Fluid
3) Peritoneal
4) Amniotic

102
Q

What bodily fluids INCREASES the risk of HIV transmission?

A

1) Blood
2) Semen
3) Vaginal secretions
4) Other blood contaminated fluid

Clinical Medicine II (9 decks)

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