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Virology Flashcards

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1
Q

What infection in a patient with a CD4+ count <100 cells/mm3 presents with non-specific systemic symptoms and lymphadenitis?

A

Mycobacterium avium-intracellulare or Mycobacterium avium complex infection

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2
Q

What is the most salient clinical difference between opportunistic infections of Candida albicans and Epstein-Barr virus?

A

White plaques are scrapable in oral thrush (Candida albicans) whereas white plaques of oral hair leukoplakia are unscrapable (Epstein-Barr virus)

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3
Q

Of the dengue and Chikungunya viruses, which is more likely to cause severe clinical symptoms that could lead to death?

A

Dengue (neutropenia, thrombocytopenia, hemorrhage, shock)

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4
Q

What molecular characteristic allows the hepatitis C virus (HCV) to evade host antibodies?

A

HCV lacks 3′-5′ exonuclease activity → no proofreading → antigenic variation of HCV envelope proteins and new viral mutant strains

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5
Q

Which 2 RNA viruses do not replicate in the cytoplasm?

A

Retrovirus and influenza virus (retroflu is outta cyt [sight])

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6
Q

What stage of hepatitis B infection does positive hepatitis B surface antigen (HBsAg), hepatitis B e antibody (anti-HBe), and hepatitis B core antibody (anti-HBc IgG) indicate?

A

Chronic hepatitis B virus (HBV) and low infectivity

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7
Q

Which 3 herpesviruses are transmitted via sexual contact?

A

Herpes simplex virus-2 (HSV-2), cytomegalovirus, and human herpesvirus-8 (HHV-8)

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8
Q

In patients with HIV, what virus can cause progressive multifocal leukoencephalopathy (PML)?

A

JC virus (polyomavirus, Junky Cerebrum)

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9
Q

Why can hepatitis D (HDV) infection only occur in conjunction with hepatitis B (HBV) infection?

A

HDV is a defective virus so it depends on the HBV HBsAg coat for entry into hepatocytes

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10
Q

If the intracellular adhesion molecule (ICAM-1) receptor is blocked, what virus will have difficulty infecting the cells?

A

Rhinovirus (binds to ICAM-1); “I CAMe to see the rhino”

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11
Q

What cells are infected by the Epstein-Barr virus?

A

Infects B cells via CD21

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12
Q

What possible sequela can occur in mumps, especially after puberty?

A

Sterility

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13
Q

What are the symptoms associated with dengue hemorrhagic fever?

A

Dengue fever with bleeding and plasma leakage (thrombocytopenia) and extremes in hematocrit (high or low)

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14
Q

Describe how the genome of progeny virus is obtained from completed partial dsDNA.

A

Host RNA polymerase transcribes mRNA from viral DNA; DNA polymerase then reverse transcribes viral RNA to DNA

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15
Q

What do IgG antibodies to hepatitis B core antigen (HBcAg) signify?

A

Chronic infection or prior exposure to hepatitis B

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16
Q

What is the RNA structure of the rhabdovirus?

A

Enveloped, single-stranded, negative-sense, linear RNA with a helical capsid

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17
Q

What is the incubation period for Ebola?

A

Up to 21 days

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18
Q

What is the pathology that leads to dengue shock syndrome?

A

Plasma leakage leading to circulatory collapse

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19
Q

Compare the incubation periods of hepatitis A, B, C, and E.

A

Hepatitis A and E: short (weeks); B and C: long (months)

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20
Q

What is the purpose of neuraminidase antigen on the parainfluenza viral membrane?

A

Promotes progeny virion release (neuraminadaways sends virus away)

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21
Q

What is the pathophysiology of the “blueberry muffin” rash seen in congenital rubella?

A

Dermal extramedullary hematopoiesis

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22
Q

What endoscopic and biopsy findings are seen in Candida albicans esophagitis?

A

White plaques on endoscopy; biopsy shows yeast and pseudohyphae

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23
Q

Name 4 medically significant conditions caused by bunyaviruses.

A

Hantavirus infection (hemorrhagic fever, pneumonia), California encephalitis, Crimean-Congo hemorrhagic fever, Sandfly/Rift Valley fevers

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24
Q

What predisposing factor significantly increases the risk of developing dengue hemorrhagic fever?

A

Infection with a different dengue virus serotype after initial infection (due to antibody-dependent enhancement of disease)

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25
Q

What is the route of transmission for hepatitis A?

A

Fecal-oral via contaminated shellfish, exposure during travel, or in daycare centers

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26
Q

Describe the symptoms caused by Zika virus infection.

A

Conjunctivitis, low-grade pyrexia, and an itchy rash (20% of cases)

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27
Q

What virus can act like Epstein-Barr virus (HHV-4) but have a negative monospot test?

A

Cytomegalovirus (HHV-5)

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28
Q

What are the 2 most common renal manifestations of hepatitis B?

A

Membranous glomerulonephritis > membranoproliferative glomerulonephritis

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29
Q

What virus causes croup?

A

Parainfluenza virus

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30
Q

Hepatitis D virus (HDV) infection needs coinfection with hepatitis B to supply the envelope protein for HDV. What is this mechanism called?

A

Complementation

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31
Q

By what mechanism does rotavirus cause gastroenteritis?

A

Rotavirus causes destruction of the intestinal villi and atrophy → ↓ reabsorption of Na+ and loss of K+

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32
Q

What vaccine has made mumps uncommon?

A

MMR (measles, mumps, rubella)

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33
Q

During which phase of HIV infection does the CD8+ T-cell count decline the most rapidly?

A

Systemic immunodeficiency/AIDS-defining illnesses phase (associated with exhaustion)

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34
Q

Describe the progression of rabies infection.

A

Fever and malaise → agitation, photophobia, hydrophobia, hypersalivation → paralysis, coma → death

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35
Q

What is the RNA structure of the flavivirus?

A

Enveloped, single-stranded, positive-sense, linear RNA with an icosahedral capsid

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36
Q

Which 2 viruses in the picornavirus family are not enteroviruses?

A

Rhinovirus and hepatitis A virus (HAV)

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37
Q

What ⊕ markers are expected in a chronic hepatitis B virus infection with high infectivity?

A

Hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and hepatitis B core antibody (anti-HBc) IgG

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38
Q

What test can be performed in the setting of an inconclusive HIV-1/2 differentiation assay?

A

HIV-1 nucleic acid test (NAT)

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39
Q

What condition in humans is caused by enteroviruses within the picornavirus family?

A

Aseptic meningitis

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40
Q

What RNA virus family does rabies belong to?

A

Rhabdoviruses

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41
Q

Why are the hepatitis B, C, and D viruses unable to spread via the fecal-oral route?

A

B, C, and D = enveloped viruses which are killed in the gut; A and E = naked viruses are not destroyed in the GI tract (vowels hit your bowels)

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42
Q

Infections with which organisms are possible when the CD4+ count is <200 cells/mm3?

A

JC virus reactivation, Pneumocystis jirovecii, HIV infection, Histoplasma capsulatum

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43
Q

Other than animal bites, how else can rabies virus be transmitted?

A

Aerosol transmission (eg, bat caves)

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44
Q

Name 2 viruses found in the reovirus family.

A

Rotavirus (fatal diarrhea in kids) and coltivirus (Colorado tick fever)

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45
Q

What are the 7 positive-stranded RNA viruses?

A

I went to a retro (Retrovirus) toga (togavirus) party, where I drank flavored (flavivirus) Corona (coronavirus) and ate hippie (hepevirus) California (calicivirus) pickles (picornavirus)

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46
Q

What hepatitis virus is associated with polyarteritis nodosa?

A

Hepatitis B

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47
Q

From what source do enveloped viruses generally obtain their envelopes?

A

From the plasma membrane as they exit the cell

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48
Q

What characteristic liver biopsy findings are seen in hepatitis C?

A

Lymphoid aggregates with focal macrovesicular steatosis

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49
Q

Which lobe of the brain is most commonly affected in herpes encephalitis?

A

Temporal lobe (implicated virus is herpes simplex virus)

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50
Q

What is the RNA structure of the hepatitis D virus (HDV)?

A

Single-stranded, negative-sense, circular RNA

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51
Q

What serologic markers would you expect in a patient immunized against Hepatitis B?

A

⊕ Anti-HBs (all other hepatitis B markers negative)

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52
Q

What is the RNA structure of the orthomyxovirus?

A

Enveloped, single-stranded, negative-sense, linear (in 8 segments) RNA with a helical capsid

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53
Q

How is infection with the Chikungunya virus diagnosed?

A

Reverse transcription-polymerase chain reaction (RT-PCR) or serology

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54
Q

What complications may occur to a fetus exposed to parvovirus B19?

A

Hydrops fetalis and fetal demise

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55
Q

Describe the DNA structure of hepadnavirus, including whether or not it is enveloped.

A

Partially double-stranded, circular DNA, enveloped

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56
Q

How does HIV integrate its genome into the host DNA?

A

Reverse transcriptase converts HIV viral RNA → double-stranded DNA → integrates into host DNA

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57
Q

What 2 groups act as reservoirs for the yellow fever virus?

A

Monkeys and humans

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58
Q

What occurs during the acute phase of infection by human immunodeficiency virus (HIV)?

A

Widespread dissemination and seeding of the lymphoid organs

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59
Q

What rodent-borne bunyavirus causes a hemorrhagic pulmonary syndrome?

A

Hantavirus

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60
Q

What is the function of hemagglutinin antigen on the parainfluenza viral membrane?

A

Promotes viral entry by binding to sialic acid (hemagglutinin brings virus in)

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61
Q

What are the typical symptoms of infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Fever, dry cough, shortness of breath fatigue (however often patients are asymptomatic)

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62
Q

What is the incubation period before symptom onset in rabies?

A

Weeks to months

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63
Q

What is the viral structure of rotavirus?

A

Segmented double-stranded RNA virus (reovirus family)

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64
Q

Name the 2 major antigens of the influenza virus.

A

Hemagglutinin and neuraminidase

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65
Q

What is the most common cause of measles-associated death in children?

A

Pneumonia

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66
Q

Which 2 picornaviruses commonly cause aseptic meningitis?

A

Echovirus and coxsackievirus

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67
Q

What ⊕ markers would you expect during the acute stage of infection with hepatitis B?

A

Hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and hepatitis B core antibody (anti-HBc) IgM

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68
Q

What presentation might cytomegalovirus infection have in a patient with a CD4+ count < 100/mm3?

A

Colitis, Retinitis, Encephalitis, Esophagitis, Pneumonitis (CREEP)

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69
Q

What is the name of the disease associated with “slapped cheeks” in children with parvovirus?

A

Erythema infectiosum or fifth disease

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70
Q

In addition to mononucleosis, name 3 diseases caused by Epstein-Barr virus infection.

A

Lymphomas (eg, Burkitt lymphoma), nasopharyngeal carcinoma (more common in Asian adults), and lymphoproliferative disease in transplant patients

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71
Q

What infection in patients with a CD4+ cell count < 500/mm3 presents with white patches on the lateral side of the tongue that cannot be scraped off?

A

Oral hairy leukoplakia (due to Epstein-Barr virus)

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72
Q

Which RNA virus family causes the often fatal diseases of Ebola and Marburg hemorrhagic fever?

A

Filoviruses

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73
Q

What is considered the normal range of CD4+ cell count?

A

500–1500 cells/mm3

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74
Q

Describe the DNA structure of poxvirus, including whether or not it is enveloped.

A

Double-stranded, linear DNA, enveloped (largest DNA viruses)

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75
Q

Which 3 herpesviruses are transmitted in respiratory secretions?

A

Herpes simplex virus-1 (HSV-1), Epstein-Barr virus (HHV-4), and varicella-zoster virus (HHV-3)

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76
Q

In which type of cells do cytomegalovirus (CMV, HHV-5) establish latency?

A

Mononuclear cells

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77
Q

What is the RNA structure of the hepevirus?

A

Non-enveloped, single-stranded, positive-sense, linear RNA with an icosahedral capsid

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78
Q

What is the RNA structure of the picornavirus?

A

Non-enveloped, single-stranded, positive-sense, linear RNA with an icosahedral capsid

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79
Q

What test is performed for definitive diagnosis of skin and genital findings suggestive of herpes simplex virus?

A

Viral polymerase chain reaction (PCR) of skin lesions

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80
Q

What is the ploidy of the HIV genome?

A

Diploid RNA (2 molecules of RNA)

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81
Q

What are initial symptoms of Ebola?

A

Abrupt onset of flu-like symptoms, high fever, diarrhea/vomiting, and myalgia

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82
Q

Hepatitis C infection confers increased risk for which hematological cancer?

A

B-cell non-Hodgkin lymphoma (NHL)

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83
Q

Which DNA virus is single stranded?

A

Parvovirus (all other DNA viruses are double stranded)

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84
Q

The HIV RNA levels peak during which phases of infection?

A

Acute infection phase and systemic immunodeficiency/AIDS-defining illnesses phase

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85
Q

How does central nervous system (CNS) lymphoma differ from a Toxoplasma gondii infection on a brain MRI of a patient who has a CD4+ count <100/mm3?

A

A solitary ring-enhancing lesion is usually seen in CNS lymphoma; multiple lesions are usually found in a Toxoplasma gondii infection

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86
Q

Name 5 RNA viruses that are picornaviruses?

A

Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, Hepatitis A virus (PERCH on a “peak” [picornavirus])

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87
Q

What kind of infections are HIV ⊕ patients generally at risk for as the CD4+ cell count drops?

A

Reactivation of past infections (eg, tuberculosis, shingles), non-Hodgkin lymphoma, dissemination of bacterial/fungal infections

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88
Q

What disease would be most likely in an unvaccinated young adult with personality changes, dementia, and autonomic dysfunction who had previously contracted rubeola as a child?

A

Subacute sclerosing panencephalitis (SSPE); occurs years after initial infection

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89
Q

In what parts of the world is hepatitis E infection most common?

A

Asia, Africa, and the Middle East

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90
Q

Which viral family includes the hepatitis D virus?

A

Delta viruses

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91
Q

Which human papillomavirus (HPV) serotypes are associated with warts?

A

Serotypes 1, 2, 6, and 11

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92
Q

What viral strains are found in the flu shot?

A

Viral strains that are most likely to appear during a flu season (reformulated vaccine)

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93
Q

What is a patient’s HIV status if the nucleic acid test (NAT) is negative following a positive HIV-1/2 Ag/Ab immunoassay?

A

HIV ⊖ (HIV Ag/Ab immunoassay was likely a false positive)

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94
Q

What is the transmission vector of the Chikungunya virus?

A

Aedes mosquito

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95
Q

What CD4+ count is associated with Toxoplasma gondii infection?

A

< 100/mm3

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96
Q

How is Ebola diagnosed?

A

Reverse transcription-polymerase chain reaction (RT-PCR) within 48 hours of symptom onset

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97
Q

Which types of hepatitis can have a carrier state?

A

Hepatitis B and C (very common in C)

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98
Q

Besides febrile pharyngitis, what other signs or symptoms could adenovirus be responsible for?

A

Acute hemorrhagic cystitis, pneumonia, conjunctivitis (“pink eye”), gastroenteritis, and myocarditis

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99
Q

What are the possible means of transmission for β-pleated prion proteins (PrPsc)?

A

Transmissible via infected CNS tissue (iatrogenic Creutzfeldt-Jakob disease) or food contaminated by bovine spongiform encephalopathy (BSE; variant Creutzfeldt-Jakob disease)

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100
Q

What is the difference between IgM versus IgG hepatitis B core antibodies?

A

IgM is a marker for acute or recent disease; IgG is a marker for prior exposure or chronic infection

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101
Q

What type of infections might be seen with HIV when the CD4+ count is 200-400 cells/mm3?

A

Skin and mucous membrane infections (generally years post-infection)

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102
Q

Which disease caused by a DNA virus has been eradicated through the use of a live-attenuated vaccine?

A

Smallpox (poxvirus family)

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103
Q

What is the genomic structure of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?

A

Enveloped ⊕ single-stranded RNA with a helical capsid

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104
Q

What is the time frame for the development of anti-envelope antibodies (gp120) following initial HIV infection?

A

Begins after the first month through the acute phase and remains elevated

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105
Q

What serological marker is best to detect acute hepatitis A?

A

IgM hepatitis A virus antibody (anti-HAV IgM)

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106
Q

What are 3 possible clinical conditions associated with infection by Dengue virus?

A

Dengue fever, dengue hemorrhagic fever, or dengue shock syndrome

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107
Q

Which well-known RNA virus family has reverse transcriptase?

A

Retrovirus

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108
Q

Name 4 segmented RNA viruses.

A

Bunyaviruses, Orthomyxoviruses (influenza), Arenaviruses, Reoviruses (BOAR)

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109
Q

What part of the nervous system does varicella-zoster virus lie latent?

A

In the dorsal root or trigeminal ganglia

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110
Q

Why are naked nucleic acids of negative-sense RNA viruses (both single- and double-stranded) not infectious?

A

They require polymerases found in the complete virion to become infectiou

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111
Q

What disease process should you consider in a patient with a CD4+ count <200/mm3, progressive memory loss, and an otherwise negative infectious work-up?

A

HIV dementia

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112
Q

What 5 diseases are caused by paramyxoviruses?

A

Parainfluenza (croup), measles, mumps, respiratory syncytial virus (RSV), and human metapneumovirus

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113
Q

What stage of hepatitis B infection does positive hepatitis B surface antibody (anti-HBs), hepatitis B e antibody (anti-HBe), and hepatitis B core antibody (anti-HBc) IgG indicate?

A

Recovery stage

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114
Q

Name 5 medically significant members of the picornavirus family.

A

Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, HAV (hepatitis A virus) (PERCH)

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115
Q

What is the mechanism of action of palivizumab?

A

Monoclonal antibody against the surface F protein preventing pneumonia caused by respiratory syncytial virus (RSV)

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116
Q

What is the RNA structure of the calicivirus?

A

Non-enveloped, single-stranded, positive-sense, linear RNA with an icosahedral capsid

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117
Q

What are 4 common clinical findings of measles?

A

Cough, Coryza, Conjunctivitis, and “C”oplik (Koplik) spots (4 C’s of Measles)

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118
Q

According to the CDC guidelines, all infants should be vaccinated against rotavirus with the exception of which medical conditions?

A

History of intussusception or severe combined immunodeficiency (SCID)

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119
Q

All segmented viruses have what type of viral genome (DNA or RNA)?

A

RNA

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120
Q

Which herpesvirus is the most common cause of mononucleosis?

A

Epstein-Barr virus (HHV-4)

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121
Q

What is the function of the hepatitis B DNA polymerase?

A

Has both DNA- and RNA-dependent activities Enters nucleus → completes partial double-stranded DNA; also reverse transcribes viral RNA → DNA for progeny genome synthesis

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122
Q

Which virus is the most important global cause of infantile gastroenteritis?

A

Rotavirus (ROTAvirus = “right out the anus”)

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123
Q

What type of viral genomic structure is necessary for viral genome reassortment?

A

A segmented genome

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124
Q

What are the functions of the influenza viral antigens hemagglutinin and neuraminidase?

A

Hemagglutinin binds sialic acid to promote viral entry (hemagglutinin lets virus in); neuraminidase promotes progeny virion release (neuraminidaways sends virus away)

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125
Q

What are the 4 stages of untreated HIV infection?

A

Flu-like (acute); Feeling fine (latency); Falling count; Final crisis (Four stages)

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126
Q

Name the 4 families of RNA viruses that have no envelope.

A

Reoviruses, picornaviruses, hepeviruses, and caliciviruses

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127
Q

What are the characteristics of the vaccine against dengue virus?

A

Live, recombinant vaccine that uses yellow fever virus genes into which dengue virus envelope and premembrane proteins are inserted

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128
Q

Chronic hepatitis B is associated with what hematologic abnormality?

A

Aplastic anemia

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129
Q

What is the source of the hepatitis B e antigen (HBeAg) found in the serum of a patient infected with hepatitis B?

A

Secretion by infected hepatocytes into the circulation; it is not part of the mature HBV virion

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130
Q

What 3 organs are affected by Kaposi sarcoma?

A

Skin, gastrointestinal tract, and lungs

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131
Q

What is expected on a biopsy of bacillary angiomatosis in a patient who is HIV ⊕?

A

Neutrophilic inflammation caused by Bartonella spp

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132
Q

How do the Epstein-Barr virus (HHV-4) and strep throat differ in the location of cervical lymphadenopathy?

A

HHV-4 is more strongly associated with posterior cervical lymphadenopathy; strep throat involves anterior cervical lymphadenopathy

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133
Q

Which herpes simplex virus is more likely to cause viral meningitis?

A

Herpes simplex virus-2 (HSV-2)

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134
Q

Why are contact sports avoided in patients with mononucleosis?

A

Risk of splenic rupture

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135
Q

What 2 vaccines can be used for poliovirus infections?

A

Salk = inactivated polio vaccine (IPV); Sabin = oral polio vaccine (OPV)

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136
Q

To what viral family does hepatitis B virus belong?

A

Hepadnaviridae

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137
Q

All DNA virus are linear with the exception of which DNA virus families?

A

Papillomaviruses, polyomaviruses, and hepadnaviruses (circular genomes)

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138
Q

What is the prognosis for most patients who do not receive treatment for HIV infection?

A

Most eventually die due to complications of HIV infection

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139
Q

What is the RNA structure of the arenavirus?

A

Enveloped, single-stranded, positive- and negative-sense, circular (in 2 segments) RNA with a helical capsid

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140
Q

What are the most common endocrine manifestations of hepatitis C?

A

↑ risk of diabetes mellitus and autoimmune hypothyroidism

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141
Q

At what levels of CD4+ cell count do infections with Mycobacterium avium-intracellulare and M avium complex most commonly occur in immunocompromised patients?

A

CD4+ cell count < 50/mm3

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142
Q

How does the monospot test work, and what is it used to detect?

A

Detects heterophile antibodies via agglutination of sheep or horse red blood cells as a method to detect Epstein-Barr virus

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143
Q

What population is vulnerable to infection by paramyxoviruses?

A

Children and infants

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144
Q

What are the characteristics of the Reovirus family?

A

Naked, multisegmented, double-stranded RNA viruses with double icosahedral capsids

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145
Q

What is the viral receptor for rabies?

A

Nicotinic acetylcholine receptor (AChR)

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146
Q

What are possible central nervous system sequelae of measles?

A

Subacute sclerosing panencephalitis (SSPE) and encephalitis

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147
Q

What rare sequela of measles can arise in the lungs, particularly in the immunosuppressed?

A

Giant cell pneumonia

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148
Q

Which DNA virus contains the reverse transcriptase enzyme in order to replicate its genome?

A

Hepadnavirus (eg, hepatitis B)

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149
Q

What is the most common complication of shingles?

A

Post-herpetic neuralgia

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150
Q

What infection is associated with a CD4+ < 200/mm3 and fever, fatigue, weight loss, cough, nausea, vomiting, dyspnea, and diarrhea?

A

Histoplasma capsulatum infection

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151
Q

What are the possible presentations in a patient with herpes simplex virus-1?

A

Cold sores, herpetic whitlow, keratoconjunctivitis, erythema multiforme, esophagitis, temporal encephalitis, and gingivostomatitis

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152
Q

What is the typical presentation of rubella (German measles) infection?

A

Fever, postauricular and other lymphadenopathy, arthralgia, and maculopapular rash

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153
Q

Coltivirus is the causative agent for which illness?

A

Coltivirus causes Colorado tick fever

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154
Q

Purified nucleic acids from which 2 double-stranded DNA viruses are not considered infectious?

A

Poxvirus and hepatitis B virus (HBV)

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155
Q

What is the RNA structure of the paramyxovirus?

A

Enveloped, single-stranded, negative-sense, linear (nonsegmented) RNA with a helical capsid

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156
Q

What antigen is associated with the core of hepatitis B virus?

A

HBcAg

157
Q

What infection presents with nonenhancing areas of demyelination on MRI in a patient with a CD4+ cell count < 200/mm3?

A

Progressive multifocal leukoencephalopathy (due to JC virus reactivation)

158
Q

In contrast to the other picornaviruses, what type of infection does rhinovirus not cause, and why?

A

Gastrointestinal tract infections; it is acid labile and destroyed by stomach acid

159
Q

Which RNA virus causes croup?

A

Parainfluenza

160
Q

What common diseases are possible in the population with HIV/AIDS when the CD4+ count is <500 cells/mm3?

A

Oral thrush (Candida albicans), oral leukoplakia (Epstein-Barr virus), Kaposi sarcoma (Human herpesvirus-8), squamous cell carcinoma (Human papillomavirus )

161
Q

Which hepatitis types can be transmitted by blood?

A

Hepatitis B, C, and D

162
Q

Name 4 medically important paramyxoviruses.

A

Parainfluenza virus (croup), Respiratory syncytial virus (RSV, infantile bronchiolitis), Mumps, and Measles (PaRaMyxovirus)

163
Q

Epstein-Barr virus is associated with what medical complications in patients with a CD4+ count < 100/mm3?

A

B-cell lymphoma (eg., non-Hodgkin lymphoma, CNS lymphoma)

164
Q

Palivizumab is used to prevent respiratory syncytial virus (RSV) in what age group?

A

Premature infants (palivizumab for paramyxovirus prophylaxis in preemies)

165
Q

What disease presents with esophagitis and linear ulcerations on esophagogastroduodenoscopy (EGD) in a patient with a CD4+ count <100/mm3?

A

Cytomegalovirus esophagitis

166
Q

How does transmission for herpes simplex virus (HSV) 1 and 2 differ?

A

HSV-1 is spread in respiratory secretions and saliva; HSV-2 is spread by sexual contact and perinatally

167
Q

What viral infections are associated with intranuclear eosinophilic Cowdry A inclusions?

A

Herpes simplex virus-1 (HSV-1), herpes simplex virus-2 (HSV-2), varicella-zoster virus (VZV)

168
Q

What is a pseudovirion?

A

The genetic material of one virus coated by the surface proteins of a different virus

169
Q

Which picornavirus causes the “common cold?”

A

Rhinovirus

170
Q

What is the test of choice for cryptosporidium infection in patients with chronic, watery diarrhea and a CD4+ count <200/mm3?

A

An acid-fast stain of the stool sample to show acid-fast oocysts

171
Q

What is the RNA structure of the filovirus?

A

Enveloped, single-stranded, negative sense, linear with a helical capsid

172
Q

Where does HIV replicate during the clinical latency phase?

A

Lymph nodes

173
Q

What are the physical findings of Kaposi sarcoma associated with human herpesvirus-8 infection with CD4+ cell count < 500/mm3?

A

Invading perivascular spindle cells that form vascular tumors visible on histology

174
Q

Describe the DNA structure of papillomavirus, including whether or not it is enveloped.

A

Double-stranded, circular DNA, non-enveloped

175
Q

Name the 2 RNA viruses that have reverse transcriptase.

A

Human immunodeficiency virus (HIV) → AIDS and human T-lymphotropic virus (HTLV) → T-cell leukemia

176
Q

Which hepatitis virus is most likely to progress to cirrhosis or carcinoma?

A

Hepatitis C; most likely to progress to Cirrhosis or Carcinoma

177
Q

To what common sterilization procedure are prion diseases known to be resistant

A

Standard autoclaving

178
Q

What DNA virus in adults can cause pure red blood cell aplasia and rheumatoid arthritis-like symptoms?

A

Parvovirus B19

179
Q

Of the 2 viruses that can cause roseola, which is a less common cause of the disease?

A

Human herpesvirus-7 (HHV-7) is a less common cause than human herpesvirus-6 (HHV-6)

180
Q

How is infection by dengue virus diagnosed?

A

Polymerase chain reaction (PCR) or serology

181
Q

Congenital rubella presents with what classic triad of clinical findings?

A

Sensorineural deafness, cataracts, and patent ductus arteriosus

182
Q

In which part of the nervous system does the herpes simplex virus-1 lie dormant after initial infection?

A

Trigeminal ganglia

183
Q

Coinfection by what virus can occur with the dengue virus?

A

Chikungunya virus (same mosquito vector)

184
Q

What type of capsid shape do most negative-sense RNA viruses have and with what exception?

A

Helical; delta viruses have an unspecified capsid symmetry

185
Q

What DNA virus is associated with “milkmaid blisters”?

A

Cowpox (Poxvirus)

186
Q

Which virus in the reovirus family causes fatal diarrhea in children?

A

Rotavirus

187
Q

All DNA viruses have double-stranded DNA genomes with what exception?

A

Parvoviridae = single-stranded DNA (ssDNA; parvovirus is “part-of-a-virus”)

188
Q

What is the RNA structure of the coronavirus?

A

Enveloped, single-stranded, positive-sense, linear RNA with a helical capsid

189
Q

What sequelae can rarely occur after infection with the rubeola virus in an immunocompromised patient?

A

Giant cell pneumonia

190
Q

A young child presents with a flesh-colored papule with central umbilication. What is the causative agent?

A

Molluscum contagiosum (poxvirus)

191
Q

What is the prognosis for hepatitis B in adults and neonates?

A

Adults = mostly a full resolution; neonates = a worse prognosis

192
Q

In which part of the nervous system does the herpes simplex virus-2 lie latent?

A

Sacral ganglia

193
Q

What is the mechanism through which parvovirus results in fetal and maternal presentation (eg, hydrops fetalis, rheumatoid arthritis-like symptoms in adults)?

A

Red blood cell destruction due to selective infection of red blood cell precursors and endothelial cells

194
Q

Which herpesvirus is the most common cause of sporadic encephalitis?

A

Herpes simplex virus-1

195
Q

Name 6 medically significant conditions caused by flaviviruses.

A

Hepatitis C, Yellow fever, St. Louis encephalitis, Zika virus infection, West Nile disease (meningoencephalitis, flaccid paralysis), and Dengue

196
Q

Describe the structure of orthomyxoviruses.

A

Enveloped, negative-sense, single-stranded RNA viruses with a segmented genome

197
Q

Which test determines appropriate antiretroviral therapy in HIV ⊕ patients?

A

HIV genotype testing

198
Q

What is the most appropriate treatment for patients infected by Zika virus?

A

Supportive care (no definitive treatment)

199
Q

How can hepatitis E be acquired?

A

Via the fecal-oral route, especially from waterborne sources

200
Q

How many RNA segments does each segmented RNA virus family have?

A

Bunyaviruses: 3 Orthomyxoviruses: 8 Arenaviruses: 2 Reoviruses: 10-12 “BOARding flight 382 in 10-12 minutes”

201
Q

What is the most common mosquito-borne viral disease in the world?

A

Dengue virus

202
Q

What 2 sensory changes may occur with infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Anosmia (loss of smell) and dysgeusia (altered taste)

203
Q

What are the differences in duration of illness of Hepatitis D virus (HDV) in relation to Hepatitis B viral (HBV) infection?

A

A superinfection (HDV after HBV) is shorter while coinfection is longer

204
Q

Which is the only positive-sense RNA viral family with a helical capsid?

A

Coronaviruses

205
Q

Which serologic marker indicates prior infection (or vaccination) with Hepatitis A and protects against reinfection?

A

IgG anti-hepatitis A virus antibody (anti-HAV IgG)

206
Q

Given the high mortality rate, what steps should be taken to prevent transmission of the Ebola virus?

A

Vaccinations, barrier practices for health care workers, and strict isolation of infected individuals

207
Q

What hepatitis virus can initially present like serum sickness (fever, arthralgias, and rash)?

A

Hepatitis B

208
Q

What human papillomavirus (HPV) serotypes are most commonly associated with cervical cancer?

A

Serotypes 16 and 18

209
Q

All DNA viruses replicate in the nucleus with the exception of which virus?

A

Poxvirus (carries its own DNA-dependent RNA polymerase, does not require nuclear enzymes)

210
Q

What viruses are part of the Togavirus family?

A

Toga CREW - Chikungunya virus, Rubella, Eastern and Western equine encephalitis

211
Q

What infection in patients with a CD4+ count < 200 cells/mm3 presents with cough, fever, and dyspnea with bilateral ground-glass opacities on chest X-ray?

A

Pneumocystis pneumonia (Pneumocystis jirovecii)

212
Q

Which nonenveloped RNA virus causes the common cold?

A

Rhinovirus (rhino has a runny nose)

213
Q

What patient population has a high mortality rate if infected with hepatitis E virus?

A

Pregnant women (HEV: Enteric, Expectant mothers, Epidemic)

214
Q

What are the typical symptoms of acute laryngotracheobronchitis?

A

“Seal-like” barking cough and inspiratory stridor (croup from parainfluenza viral infection)

215
Q

Name the 6 negative-stranded viral families.

A

Arenaviruses, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Filoviruses, Rhabdoviruses (Always Bring Polymerase Or Fail Replication)

216
Q

Which 2 diseases are caused by arenaviruses?

A

Lymphocytic choriomeningitis virus (LCMV) and Lassa fever encephalitis (spread by rodents)

217
Q

How does cytomegalovirus infection present on fundoscopy?

A

Cotton-wool spots

218
Q

What infectious entity causes high fever, black-colored vomitus, jaundice, hemorrhage, and backache?

A

Yellow fever virus

219
Q

What is the mechanism behind phenotypic mixing?

A

Two viruses coinfect a cell → virus A becomes coated with virus B proteins → progeny have type A genome and coat

220
Q

What is the test of choice for herpes simplex virus (HSV) encephalitis?

A

HSV polymerase chain reaction (PCR) of the cerebrospinal fluid

221
Q

Name 8 naked (nonenveloped) viruses.

A

Calicivirus, Picornavirus, Reovirus, Parvovirus, Adenovirus, Papillomavirus, Polyomavirus, and Hepevirus (give CPR and a PAPP smear to a naked hippie)

222
Q

Describe how genetic/antigenic shift occurs.

A

1 cell is infected by 2 different segmented viruses → RNA segment reassortment → dramatically different virus → major global outbreaks

223
Q

Which RNA virus family does Ebola hemorrhagic fever belong to?

A

Filoviruses

224
Q

What is the purpose of the RNA-dependent RNA polymerase that ⊖ strand RNA viruses carry?

A

Transcribes ⊖ strand → ⊕ in the host cell in order to replicate

225
Q

Which antibody is protective against hepatitis B infection acquired after recovery from an infection or vaccination?

A

Hepatitis B surface antibody (anti-HBs)

226
Q

What malignancy is associated with human papillomavirus infection in the population with HIV/AIDS?

A

Squamous cell carcinoma of the anus, cervix, and oropharynx

227
Q

What 3 fatal bacterial superinfections most commonly occur with influenza virus infection?

A

Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae

228
Q

What are the clinical manifestations of congenital Zika syndrome?

A

Microcephaly, ocular anomalies, motor abnormalities (eg, spasticity, seizures)

229
Q

Viruses A and B infect a cell. Virus A mutates and becomes nonfunctional while virus B expresses a protein that serves both A and B. What is this mechanism called?

A

Complementation

230
Q

Coronaviruses are the causative agents of what 4 diseases?

A

Common cold, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and COVID-19

231
Q

Which animal bites are most likely to result in rabies infection in the United States?

A

Bat, raccoon, and skunk bites > dog bites

232
Q

Parvovirus B19 uses what receptor to attach to red blood cells?

A

P antigen on red blood cells (Parvovirus)

233
Q

For infection with Hepatitis D virus (HDV) and Hepatitis B virus (HBV), what incubation state has the worse prognosis?

A

Superinfection (HDV after HBV)

234
Q

What is the test of choice for the diagnosis of Zika virus?

A

Reverse transcription polymerase chain reaction (RT-PCR) or serology

235
Q

What is the definition of viral genetic recombination?

A

Gene exchange between 2 chromosomes via crossing over within regions of homologous base sequences

236
Q

What are the criteria for the diagnosis of acquired immunodeficiency syndrome (AIDS)?

A

CD4+ count ≤200 cells/mm3 or HIV ⊕ with an AIDS-defining illness

237
Q

How do you evaluate response to antiretroviral therapy for HIV?

A

Test the amount of viral RNA in plasma

238
Q

What 3 hematologic manifestations can occur in hepatitis C infection?

A

Essential mixed cryoglobulinemia, idiopathic thrombocytopenic purpura (ITP), and autoimmune hemolytic anemia (AIHA)

239
Q

What mediates the granular eosinophilic “ground glass” appearance found on a liver biopsy specimen of hepatitis B?

A

Due to accumulation of surface antigen in infected hepatocytes and cytotoxic T-cell-mediated damage

240
Q

Which organ transplant does the BK virus commonly target?

A

Kidneys (BK virus = Bad Kidney virus)

241
Q

What CD4+ count is associated with oral thrush from a Candida albicans infection in patients with HIV?

A

<500 cells/mm3

242
Q

What is the most common diagnostic test used to determine infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Reverse transcriptase-polymerase chain reaction (RT-PCR); antigen and antibody tests are also available

243
Q

What is the RNA structure of the togavirus?

A

Enveloped, single-stranded, positive-sense, linear RNA with an icosahedral capsid

244
Q

What are 6 significant risk factors for severe illness or death secondary to infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Age, obesity, diabetes, hypertension, chronic kidney disease (CKD), and severe cardiopulmonary illness

245
Q

What double-stranded, linear DNA virus can cause conjunctivitis, myocarditis, and febrile pharyngitis?

A

Adenovirus

246
Q

What is the treatment of choice for Ebola?

A

Supportive care (no definitive treatment)

247
Q

To which virus family does rhinovirus belong?

A

Picornavirus

248
Q

What is seen on biopsy of tissues infected with cytomegalovirus?

A

Cells with intranuclear inclusion bodies (owl’s eye appearance)

249
Q

What is the primary pattern of transmission for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Respiratory droplets and aerosols

250
Q

Describe the DNA structure of parvovirus, including whether or not it is enveloped.

A

Single-stranded, linear DNA, non-enveloped (smallest DNA virus)

251
Q

What signs and symptoms are characteristic of all hepatitis viruses?

A

Fever, jaundice, and ↑ alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

252
Q

What infection in patients with a CD4+ count <100 cells/mm3 presents with pleuritic chest pain, and hemoptysis?

A

Aspergillus fumigatus

253
Q

What prion disease causes typically sporadic, rapidly progressive dementia?

A

Creutzfeldt-Jakob disease

254
Q

From what cells does Kaposi sarcoma arise?

A

Endothelial cells

255
Q

How are HIV envelope proteins acquired?

A

Acquired via budding from the host cell plasma membrane

256
Q

What are the viral receptors for HIV?

A

CD4, CXCR4, and CCR5

257
Q

What is the route of transmission for the yellow fever virus?

A

Aedes mosquitos

258
Q

Which hepatitis viruses do not have carrier states?

A

Hepatitis A and E

259
Q

What are potential complications of infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Respiratory failure, hypercoagulability, shock, organ failure, death

260
Q

Describe the DNA structure of herpesviruses, including whether or not they are enveloped.

A

Double-stranded, linear DNA, enveloped

261
Q

How are human herpesviruses-6 and -7 transmitted?

A

Saliva

262
Q

What are 3 severe complications of Ebola?

A

Disseminated intravascular coagulation (DIC), diffuse hemorrhage, and shock (high mortality rate)

263
Q

How is the reovirus genome unique among RNA viruses?

A

It has double-stranded RNA; all other RNA viruses are single stranded

264
Q

Describe the lymph node biopsy findings of a patient with measles.

A

Warthin-Finkeldey giant cells (fused lymphocytes) present in a background of paracortical hyperplasia

265
Q

All RNA viruses have single-stranded RNA genomes except which viral family?

A

Reoviridae = double-stranded RNA (“repeatovirus”, reovirus)

266
Q

How does severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) gain entry into host cells?

A

Attachment of viral spike protein to angiotensin-converting enzyme 2 (ACE2) receptor on cell membranes

267
Q

What are 3 general mechanisms for Zika virus transmission?

A

Aedes mosquito bites (most common); sexual and vertical transmission can also occur

268
Q

What intervention can reduce morbidity and mortality in children infected with the rubeola virus?

A

Vitamin A (especially in malnourished children)

269
Q

Once picornavirus RNA has entered the cell, what is the process by which functional viral proteins are generated?

A

The RNA is translated into a single polypeptide then cleaved by virus-encoded proteases into functional viral proteins

270
Q

What is a distinguishing characteristic of the hepatitis D virus as an infectious agent?

A

Hepatitis D is a “defective” virus because it requires co-infection with hepatitis B virus to replicate

271
Q

What causes pandemics versus epidemics?

A

Genetic/antigenic shift causes pandemics; genetic/antigenic drift causes epidemics (sudden shift is more deadly than gradual drift)

272
Q

Describe the DNA structure of polyomavirus, including whether or not it is enveloped.

A

Double-stranded, circular DNA, non-enveloped

273
Q

Which RNA virus family does the influenza virus belong to?

A

Orthomyxoviruses

274
Q

What viral infection is associated with aplastic crises in sickle cell disease?

A

Parvovirus B19

275
Q

What would you see on the liver biopsy of a patient infected with hepatitis A?

A

Hepatocyte swelling, monocyte infiltration, and Councilman bodies

276
Q

Rhinovirus has how many serotypes?

A

>100 serologic types of rhinovirus

277
Q

Describe the DNA structure of adenovirus, including whether or not it is enveloped.

A

Double-stranded, linear DNA, non-enveloped

278
Q

The Chikungunya virus is a member of what viral family

A

Alphavirus member of the togavirus family

279
Q

What are symptoms of mumps?

A

Parotitis, Orchitis, aseptic Meningitis, Pancreatitis (mumps makes your parotid glands and testes as big as POM-Poms)

280
Q

What is the definition of moderately immunocompromised in HIV?

A

CD4+ count: 200-400 cells/mm3

281
Q

What might a liver biopsy reveal in a patient diagnosed with yellow fever?

A

Councilman bodies (eosinophilic apoptotic globules)

282
Q

As an exception to most other enveloped viruses, from what cellular structure in their hosts do the herpesviruses acquire their envelopes?

A

Nuclear membrane

283
Q

What virus family causes respiratory tract infections (including bronchiolitis and pnuemonia) in infants?

A

Paramyxoviruses

284
Q

What is the RNA structure of the deltavirus?

A

Enveloped, single-stranded, negative-sense, circular RNA with an uncertain capsid symmetry

285
Q

How do intramuscular and intranasal flu vaccines differ?

A

Injection contains killed virus (more common); nasal spray has a live attenuated virus (temperature sensitive, replicates in the nose)

286
Q

Cranial nerve V1 involvement of varicella-zoster virus results in what disease?

A

Herpes zoster ophthalmicus

287
Q

What 3 DNA viruses have circular genomes?

A

Hepadnavirus (circular, incomplete), papillomavirus (circular, supercoiled), and polyomavirus (circular, supercoiled)

288
Q

How might a patient infected with hepatitis A virus typically present?

A

Acute and self-limiting in adults; Asymptomatic in children

289
Q

Which DNA virus is not icosahedral in shape?

A

Poxvirus (complex)

290
Q

What are the tests of choice for cryptococcal meningitis infection?

A

Capsular antigen ⊕ or India ink stain to reveal encapsulated yeast

291
Q

What is the function of the 2 envelope proteins on the surface of HIV?

A

Gp120 helps HIV adhere to CD4+ T cells; gp41 facilitates HIV fusion/entry

292
Q

What is the mechanism by which rabies virus causes infection?

A

Binds to acetylcholine receptors on nerve axons, then migrates to the CNS in a retrograde fashion via dynein motor proteins

293
Q

How is hepatitis B acquired?

A

Parenteral (Blood), sexual (Baby-making), perinatal (Birthing)

294
Q

What class of viruses does the virus causing rubella (German Measles) belong to?

A

Togavirus

295
Q

Which populations are at particularly high risk for rotavirus in the US?

A

Infants and young children, especially in day care centers and kindergartens during the winter

296
Q

What are the clincal findings of opportunistic infection by Bartonella spp in a patient with a CD4+ count < 100/mm3?

A

Multiple red to purple papules or nodules

297
Q

Describe the viral structure of all herpesviruses.

A

Enveloped, double-stranded, and linear DNA viruses

298
Q

What are the capsid differences between retroviruses human T-cell leukemia virus (HTLV) and human immunodeficiency virus (HIV)?

A

HTLV = icosahedral; HIV = complex and conical

299
Q

What RNA virus family contains the hepatitis E virus?

A

Hepevirus

300
Q

What virus family does Ebola belong to?

A

Filovirus

301
Q

Describe the cutaneous findings of Kaposi sarcoma.

A

Dark, violaceous plaques/nodules resembling vascular proliferation caused by human herpesvirus-8

302
Q

What 3 virus families have circular RNA structures?

A

Arenaviruses, bunyaviruses, and delta viruses

303
Q

What is the test of choice for determining maternal HIV transmission to a newborn child?

A

HIV viral load in the newborn

304
Q

In what central nervous system tissue are Negri bodies commonly found in rabies infection?

A

Cerebellum (Purkinje cells) and/or hippocampus

305
Q

What herpesvirus can cause shingles, encephalitis, and pneumonia?

A

Varicella-zoster virus (HHV-3)

306
Q

What CD4+ count is associated with esophagitis from a Candida albicans infection in patients with HIV/AIDS?

A

<100 cells/mm3

307
Q

What disease does respiratory syncytial virus (RSV) cause in babies?

A

Bronchiolitis

308
Q

In which viral family do viruses have single-stranded, circular RNA that is both positive sense and negative sense (ambisense)?

A

Arenaviruses

309
Q

Which HIV proteins are encoded from the gag gene and located in the matrix and capsid?

A

p17 (matrix) and p24 (capsid)

310
Q

What are the 6 common symptoms of dengue fever?

A

Fever, headache, rash, myalgia, arthralgia, neutropenia

311
Q

What gene mutation can cause immunity to HIV?

A

Homozygous CCR5 mutation

312
Q

Describe how genetic/antigenic drift occurs.

A

Random mutations in hemagglutinin (HA) or neuraminidase (NA) genes cause frequent minor changes → major global outbreaks

313
Q

Name the 7 DNA viruses.

A

Hepadnavirus, Herpesvirus, Adenovirus, Poxvirus, Parvovirus, Papillomavirus, and Polyomavirus (HHAPPPPy viruses)

314
Q

What prion disease is notable in tribal populations practicing human cannibalism?

A

Kuru

315
Q

A patient with mononucleosis is wrongly prescribed an antibiotic and develops a rash. What antibiotic is it?

A

Amoxicillin (occurs when presumed streptococcal pharyngitis is treated in a patient with mononucleosis)

316
Q

The Centers for Disease Control (CDC) no longer recommends what confirmatory testing for HIV?

A

Western blot

317
Q

What is the RNA structure of the retrovirus?

A

Enveloped, single-stranded, positive-sense, linear (2 copies) RNA with either an icosahedral capsid or a complex, conical capsid

318
Q

What is the treatment for flu caused by influenza viruses?

A

Supportive +/– neuraminidase inhibitors (oseltamivir, zanamivir, etc.)

319
Q

What is the difference in likely transmissibility between testing positive for hepatitis B e antigen (HBeAg) compared to hepatitis B e antibody (anti-HBe)?`

A

HBeAg indicates active viral replication (high transmissibility and poorer prognosis); anti-HBe indicates low transmissibility

320
Q

How can cytomegalovirus be transmitted?

A

Via sexual contact, transfusion, urine, saliva, organ transplants, and congenitally

321
Q

Why is HIV-1/2 Ag/Ab testing not recommended in babies with suspected HIV?

A

Results are confounded due to maternally transferred HIV antibodies

322
Q

Under what conditions are outbreaks of Zika virus more common?

A

Tropical and subtropical climates

323
Q

What is the RNA structure of the bunyavirus?

A

Enveloped, single-stranded, negative-sense, circular (in 3 segments) RNA with a helical capsid

324
Q

What dermatological conditions can be seen in patients with hepatitis C?

A

Sporadic porphyria cutanea tarda and lichen planus

325
Q

What are the symptoms of systemic infection by the Chikungunya virus?

A

Inflammatory polyarthritis (can become chronic), high fever, maculopapular rash, headache, and lymphadenopathy; hemorrhagic fever is uncommon compared to dengue fever

326
Q

What condition is caused by West Nile virus?

A

Meningoencephalitis

327
Q

What vascular pathology can occur with hepatitis C?

A

Leukocytoclastic vasculitis

328
Q

Name 2 coreceptors HIV can use to enter immune cells and associated stages of infection.

A

CCR5 (on macrophages for early infection) and CXCR4 (on T cells for late infection)

329
Q

Name 5 medically significant conditions caused by coxsackieviruses.

A

Aseptic meningitis, pericarditis, myocarditis, herpangina (mouth blisters and fever), and hand, foot, and mouth disease

330
Q

What is the role of the surface F (fusion) protein that is common to all paramyxoviruses?

A

Causes respiratory epithelial cells to fuse and become multinucleated cells

331
Q

What are 4 primary ways by which Ebola virus is transmitted?

A

Direct contact with bodily fluids, fomites (including corpses), infected bats/primates, and nosocomial infection (high incidence)

332
Q

What does the window period found during infection with Hepatitis B refer to?

A

The period where serum hepatitis B surface antibody (HBsAg) drops to undetectable levels, while serum anti-HBs begin to form (5-6 months post-infection)

333
Q

What 5 clinical manifestations does β-pleated prion protein (PrPsc) accumulation cause?

A

Spongiform encephalopathy, dementia, ataxia, startle myoclonus, and death

334
Q

Which calicivirus commonly causes viral gastroenteritis?

A

Norovirus

335
Q

During which phase of HIV infection does the CD4+ cell count drop most sharply?

A

Acute phase (first 1-2 months)

336
Q

What does a heterozygous CCR5 gene mutation indicate for the disease course in a patient with HIV?

A

Slower disease course

337
Q

Name the family of each of the hepatitis viruses (Hepatitis A, B, C, D, and E).

A

HAV - RNA picornavirus; HBV - DNA hepadnavirus; HCV - RNA flavivirus; HDV - RNA deltavirus; HEV - RNA hepevirus

338
Q

What is the disease condition also named “mad cow disease”?

A

Bovine spongiform encephalopathy (BSE)

339
Q

What is the vector of transmission for the Dengue virus?

A

Aedes mosquito

340
Q

What 3 treatment modalities are available to treat hospitalized patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)?

A

Remdesivir (nucleoside analog), convalescent plasma, and dexamethasone (treats cytokine release syndrome)

341
Q

In phenotypic mixing, what determines the tropism (infectivity) of a progeny virus?

A

The protein coat of the hybrid virus

342
Q

What does a positive test for hepatitis B surface antigen (HBsAg) indicate?

A

Active hepatitis B infection

343
Q

What should be done for postexposure prophylaxis in rabies?

A

Clean the wound and administer killed rabies vaccine and rabies immune globulin (passive-active immunity)

344
Q

What is the purpose of the HIV-1/2 differentiation immunoassay following a positive HIV-1/2 Ag/Ab immunoassay?

A

Determines whether it is HIV-1 or HIV-2 infection

345
Q

What findings would you expect on neuroimaging in a patient with HIV dementia with CD4+ cell count <200/mm3?

A

Cerebral atrophy

346
Q

Which DNA viruses have the smallest and largest structures?

A

Parvovirus is the smallest; poxvirus is the largest

347
Q

Two segmented viruses undergo reassortment and produce a new, highly virulent strain. What is this mechanism called?

A

Antigenic shift (associated with reassortment)

348
Q

How does the rash seen in roseola infantum spread anatomically?

A

Starts on the trunk and then spreads to extremities

349
Q

In viral genetics, what is the definition of reassortment?

A

The exchange of genetic material among viruses with segmented genomes (eg, the influenza virus)

350
Q

If the receptor CD21 is blocked, what virus will have difficulty infecting the cells?

A

Epstein-Barr virus (EBV)

351
Q

How can cytomegalovirus present in immunocompetent patients compared to immunocompromised patients?

A

Immunocompetent = mononucleosis; immunocompromised = retinitis, esophagitis, and infection (eg, pneumonia in transplant patients)

352
Q

What is the mode of transmission for hepatitis C virus?

A

Primarily blood (eg, intravenous drug use or blood transfusions)

353
Q

What are the viral receptors for CMV?

A

Integrins (heparan sulfate)

354
Q

Describe the shape of the rabies virus

A

Bullet-shaped

355
Q

At what CD4+ count are acquired immunodeficiency syndrome- (AIDS) defining illnesses expected to emerge in HIV?

A

<200 cells/mm3

356
Q

What is the function of the env gene of HIV?

A

Encodes gp160 precursor that is cleaved into gp120 and gp41

357
Q

What findings might be seen on fundoscopic exam in a patient with vision loss due to cytomegalovirus retinitis?

A

Hemorrhage and cotton-wool exudates (associated with AIDS)

358
Q

Hemorrhage and cotton-wool exudates (associated with AIDS)

A

Normal prion protein (PrPc) converts predominantly α-helical protein → β-pleated form (PrPsc); resist proteases and facilitate further conversion of PrPc → PrPsc

359
Q

To which class of viruses does yellow fever virus belong?

A

Flavivirus; also an arbovirus

360
Q

Name 3 enveloped DNA viruses.

A

Herpesvirus, Hepadnavirus, P​​​​​​​oxvirus (enveloped DNA viruses Have Helpful Protection

361
Q

Name the proteins for which each of these HIV genes code: env, gag, pol.

A

env: gp120 and gp41; gag: p24 and p17; pol: Reverse transcriptase, Integrase, Protease (RIP “Pol” [Paul])

362
Q

What does the HIV-1/2 Ag/Ab immunoassay detect?

A

Viral p24 capsid protein antigen and IgG antibodies to HIV-1/2

363
Q

What is the Tzanck test?

A

An outdated diagnostic test that uses a smear of an open skin vesicle to detect multinucleated giant cells associated with herpes simplex virus (HSV) infections

364
Q

What biopsy findings are associated with a Histoplasma capsulatam infection in patients with CD4+ cell count < 100/mm3?

A

Macrophages containing oval yeast cells

365
Q

What rare CNS sequelae of measles infection occurs a few days following the development of the classic rash?

A

Encephalitis (1:1000 cases)

366
Q
A
366
Q

Describe the type of virus shown in the image.

A

Bacteriophage

367
Q

What disease condition is most likely in a child who presents with epigastric pain and enlarged parotid glands seen in the picture (image)?

A

Mumps (causing parotitis and pancreatitis)

368
Q

What is depicted from the Tzanck test shown (image)?

A

Multinucleated giant cells

369
Q

Describe the type of virus shown in the image based on 1) the presence of envelope and 2) capsid type.

A

Naked virus with an icosahedral capsid

370
Q

What is the name of the cytoplasmic inclusions found in Purkinje cells of the cerebellum and hippocampus in rabies (image)?

A

Negri bodies

371
Q

Explain the finding in the blood smear shown (image) from a patient with mononucleosis due to infection by Epstein-Barr virus.

A

Atypical lymphocytes (reactive cytotoxic T cells)

372
Q

Describe the type of virus shown in the image based on 1) the presence of envelope and 2) capsid type.

A

Enveloped virus with an icosahedral capsid

373
Q

What is the most likely diagnosis for a child presenting with a maculopapular rash and the oropharyngeal exam findings shown (image)?

A

Measles (rubeola); the oropharynx exam shows Koplik spots (bright red spots with blue-white centers on buccal mucosa)

374
Q

A college student reports malaise, fevers, sore throat, and abdominal pain. An abdominal CT scan is shown (image). What is the most likely diagnosis?

A

Mononucleosis due to Epstein-Barr virus infection (image demonstrates associated hepatosplenomegaly)

375
Q

This itchy rash is seen on a 4-year-old boy in daycare (image). What is the most likely infectious agent?

A

Varicella-zoster virus (chickenpox)

376
Q

This virus was isolated from aerosols taken from a bat cave (image). What virus is it?

A

Rabies virus (classic bullet-shaped virion)

377
Q

Diagnosis of the cutaneous plaques shown (image)?

A

Kaposi sarcoma (vascular proliferations); seen in HIV/AIDS and transplant patients

378
Q

Each winter, a woman presents with the bothersome lip lesion shown (image). Most likely diagnosis?

A

Herpes labialis (cold sores) caused by the herpes simplex virus-1 (HSV-1)

379
Q

Diagnosis of the unilateral rash shown in the image?

A

Shingles due to reactivation of latent varicella-zoster virus

380
Q

What is the name of the ocular findings (image) found with human simplex virus-1 infection?

A

Keratoconjunctivitis

381
Q

Which 2 viruses cause high fever in children <2 years old for several days that can cause seizures, followed by the diffuse rash shown (image)?

A

Human herpesviruses-6 and -7; roseola infantum or exanthem subitum (Roseola: fever first, Rosy [rash] later)

382
Q

What is the cause of disease for a patient presenting with the sign shown on this plain film (image)?

A

Croup (“steeple sign” from narrowing of upper trachea and subglottis during parainfluenza viral infection)

383
Q

A newborn infant with microcephaly had brain imaging revealing findings shown (image). What is the likely diagnosis?

A

Congenital Zika syndrome (ventriculomegaly, subcortical calcifications)

384
Q

What is the most likely cause for the development of a maculopapular rash that starts at the head and spreads caudally on a young child as shown (image)?

A

Rubeola virus (Measles)

385
Q

A febrile child has a fine, maculopapular rash that started on his face and spread to his trunk and extremities (image). What is the most likely cause?

A

Rubella virus (rubella or German measles)

386
Q

Which virus has the classic histological findings of “owl eyes,” as seen in the image?

A

Cytomegalovirus (HHV-5)

387
Q

What virus is the cause of the disease in the image (location: genitals)?

A

Herpes simplex virus-2

388
Q

This virus was isolated from a health care worker volunteering in Sub-Saharan Africa (image). With which virus is the patient infected?

A

Ebola virus

Microbiology (7 decks)

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