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MED4 MIC > Virology > Flashcards

Virology Flashcards

1
Q

Intrauterine vs perinatal infection

A

before birth vs in 1w after birth

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2
Q

5 significant intrauterine infections

A

Rubella
CMV
VZV
Parvovirus B19
Zika

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3
Q

3 important perinatal infections

A

HSV1/2
Enterovirus
HPV

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4
Q

How many adults are immune to rubella?

A

90%

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5
Q

Transmission of rubella

A

Aerosol

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6
Q

Presentations of rubella (3)

A

morbilliform rash (face to trunk to limbs)
fever, malaise
small joint pain

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7
Q

Congenital infection of rubella and sequels on the foetus

A

<12w: congenital rubella syndrome (90%)
cataract, glaucoma, deafness, retardation, PDA, DM
12~16w: deafness (20%)

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8
Q

Diagnosis of rubella

A
  1. Serology (IgM, serum acute + convalescent)
  2. PCR on urine / NPA / amniotic fluid
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9
Q

Management for congenital rubella syndrome

A

<16w: counselling for termination of pregnancy
isolation

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10
Q

Vertical transmission rate of CMV

A

40% for primary infection
1-3% for activation / reinfection

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11
Q

Congenital infection of CMV (2)

A

Congenital cytomegalic disease (10-15%)
deafness (10%)

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12
Q

Diagnosis of CMV congenital infection

A

[before birth] amniotic fluid PCR
[after birth] urine / saliva PCR

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13
Q

Why CMV serology is not applicable in screening and diagnosis of congenital infection? (3)

A
  • CMV IgG +ve in most adults –> screening not effective
  • immaturity of baby to produce IgM
  • could be FP by passively acquiring IgG from mother
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14
Q

What’s the difference between congenital and post-natal infection of CMV? How to determine which is which?

A
  • post-natal infection will not cause cytomegalic disease
  • if sample +ve within 3 weeks, it must be congenital. Otherwise it is hard to determine
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15
Q

% of adults with VZV IgG +ve

A

90%

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16
Q

Congenital infection of VZV: timeframe

A

<20w: congenital varicella syndrome (1~2%)
>20w: zoster
perinatal (5d pre and 2d post): severe congenital varicella syndrome (fatal)

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17
Q

Diagnosis of VZV congenital infection

A

clinical (seldom do vesicular swab)

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18
Q

Management for risk of VZV congenital infection

A

Post-exposure prophylaxis by VZIG if the mother is susceptible

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19
Q

% of adults having Parvovirus B19 IgG

A

30%

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20
Q

Transmission of parvovirus B19

A

aerosol, blood products

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21
Q

Presentations of parvovirus B19 infection

A
  • 50% asymptomatic
  • 5th disease / erythema infectiosum (“slapped face” rash)
  • arthritis
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22
Q

Congenital infection of parvovirus B19

A

all or none
anaemia, hydrops fetalis (25~33%)

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23
Q

Transmission of Zika

A

vector borne, sexual, blood transfusion
intra-uterine, breast milk

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24
Q

Diagnosis of Zika congenital infection

A

[Before birth]
1. Serology: IgM (acute + convalescent)
2. PCR on urine & blood
(timing: within 14 days from onset / back from endemic areas)
3. PCR on aminotic fluid / cord blood
[After birth]
- <7d: PCR on CSF
- >7d: IgM

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25
Q

Antenatal screening in HK (3)

A

Rubella IgG
HBsAg
HIV antibodies

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26
Q

What if antenatal screening reveals HBsAg positive on a pregnant lady?

A
  • give antiviral (tenofovir) for mother at ~32w
  • give hyperimmune globulin + vaccine for newborn
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27
Q

Which congenital infection can result in microcephaly? (2)

A

VZV, Zika

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28
Q

Vector for Zika virus

A

Aedes mosquitoes

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29
Q

Respiratory viruses that are more common in children (2)

A

RSV, Parainfluenza

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30
Q

Respiratory viruses (7)

A

Influenza, Adenovirus, RSV, Parainfluenza
Rhinovirus, Enterovirus, Coronavirus

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31
Q

Basic virology for influenza virus (family, genome, replication, envelop?)

A

Family: Orthomyxoviridae
Genome: (-) ssRNA, 8 segments
Replication: in nucleus
Enveloped with antigens

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32
Q

Types of antigens of Influenza virus (number of subtypes)

A

Haemaglutinin (18), Neuraminidase (11)

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33
Q

Groups of influenza virus

A

A~D (MC is A, only A, B, C infect human)

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34
Q

Diagnosis for influenza virus (2)

A

NPA for RT-PCR
Rapid antigen test by direct IF assay

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35
Q

3 classes of antivirals against influenza virus, examples of drugs (2+2+1), actions

A

M2 ion channel blocker:
- Amantadine, Rimantadine
- inhibit viral uncoating
Neuraminidase inhibitor:
- Zanamivir, Oseltamivir
- inhibit release
Cap depenpent endonuclease inhibitor:
- Baloxavir
- inhibit RNA transcription

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36
Q

Which class of antiviral against influenza is for group A only

A

M2 ion channel blocker

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37
Q

Vaccine types for influenza (2)

A
  1. Inactivated vaccine (injected)
  2. Live attenuated vaccine (intranasal)
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38
Q

Which pathogen causes formation of multinulceated giant cells?

A

RSV

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39
Q

Family and groups of RSV

A

Pneumoviridae
A, B

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40
Q

MC pneumonia in children

A

RSV

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41
Q

Treatment / Prophylaxis for RSV

A

Palivizumab 帕利非

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42
Q

Serotypes of parainfluenza virus

A

1,2,3,4a,4b

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43
Q

Subgenera of adenovirus

A

A~G

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44
Q

Family, genome, and groups of Rotavirus

A

Reoviridae, dsRNA, A~E

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45
Q

MC viral GE inchildren

A

Rotavirus

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46
Q

Diagnosis of rotavirus

A

Stool or rectal swab
antigen detection by enzyme immunoassay or latex agglutination
(microscopy)

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47
Q

Vaccines for rotavirus (2) (nature) (time) (complication)

A

RotaRix, RotaTeq
[oral] live attenuated vaccine

1st dose 6-15w, 2nd dose before 32w
intussuception

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48
Q

Which 2 serotypes of adenovirus can cause enteric infection?

A

40, 41

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49
Q

2nd MC viral GE in children

A

adenovirus

50
Q

MC viral GE in adults

51
Q

Pathogen for winter vomiting disease

52
Q

Pathogen for projectile vomiting

53
Q

Diarrhoeal viruses (5)

A
  1. Rotavirus
  2. Adenovirus
  3. Astrovirus
  4. Norovirus
  5. Norwalk virus
54
Q

Family and genome for each hepatic virus (which 2 viruses are enveloped?)

A

HAV: picornaviridae, (+) ssRNA
HBV: hepadnaviridae, dsDNA
HCV: flaviviridae, (+) ssRNA
HDV: /
HEV: hepeviridae, (+) ssRNA
(HBV, HCV)

55
Q

Which hepatic viruses
(a) have HCC risk?
(b) have vaccine available?

A

(a) HBV, HCV
(b) HAV, HBV

56
Q

Diagnosis of infection of each hepatic virus

A

HAV: HAV IgM
HBV: HBsAg, HBV DNA
HCV: HCV combo assay (IgG + core Ag), RNA
HEV: HEV IgM, PCR

57
Q

Vaccine type for HAV

A

inactivated vaccine (monovalent or bivalent)

58
Q

How many genotypes of HEV are there? Which is prevalent in East Asia / HK?

59
Q

Which pathogen shows Dane particle under microscope?

60
Q

HBV chronic infection diagnosis

A

HBsAg +ve >6 months

61
Q

Implication of anti-HBs, anti-HBc IgM IgG, HBeAg, anti-HBe

A

anti-HBs ==> immunity
anti-HBc IgM ==> recent infection
anti-HBc IgG ==> previous infection
HBeAg ==> high infectivity
anti-HBe ==> low infectivity

62
Q

When does universal immunization for HBV start?

63
Q

Vaccine type for HBV

A

recombinant subunit vaccine

64
Q

Treatment for HBV

A

Interferons
Antivirals (Entecavir, Tenofovir)

65
Q

Which antiviral is preferred for HBV in pregnancy?

66
Q

Treatment for HCV

A

Peg-interferon, Ribavirin

67
Q

Family, genus, genome, types of HIV

A

Retroviridae, Lentivirus, ssRNA-RT, 1&2

68
Q

Which type of HIV is found mainly in Africa?

69
Q

Clinical course of HIV

A
  1. Seroconversion illness (IM-like symptoms)
  2. Latent phase
  3. Acquired immunodeficiency syndrome
70
Q

Diagnostic algorithm for HIV and diagnosis of AIDS

A

Diagnostic algorithm:
1. 4th generation HIV1/2 immunoassay
(if positive –> step 2)
2. HIV1/2 Ab differentiation immunoassay
(if negative –> step 3)
3. HIV RNA PCR
AIDS:
1. Lab confirmed HIV
2. CD4+ T cell count <200 cells/mm^3 or <14%, or AIDS defining conditions

71
Q

Treatment for HIV

A

HAART (highly active anti-retroviral therapy)
1. Dual NRTI (nucleoside/-tide reverse transcriptase inhibitor)
2. Adjuvant (1 out of 3)
a. NNRTI
b. protease inhibitor
c. integrase strand-transfer inhibitor

72
Q

Which virus family look like sunny egg under EM?

A

Herpesviridae

73
Q

Which herpes viruses do not have a high prevalence?

A

HSV2, HHV-8

74
Q

Which herpes viruses are not dermatotropic?

75
Q

Which herpes viruses are not neurolatent?

A

EBV, CMV, HHV8

76
Q

Which herpes viruses are not lympholatent?

A

HSV1, HSV2, VZV

77
Q

Transmission of HSV1 and HSV2

A

HSV1: kissing
HSV2: sexual transmission
also perinatal

78
Q

Latency region for HSV1,2

A

local sensory DRG (e.g. trigeminal, sacral ganglion)

79
Q

Diagnosis of HSV1,2

A
  1. [CSF] PCR
  2. [Skin scrape] IF
  3. [Vesicular fluid] PCR, viral culture
80
Q

Treatment for HSV1,2

81
Q

What are the only 2 airborne viruses?

A

Measles, VZV

82
Q

Treatment for post-herpetic neuralgia

A

Amitriptyline

83
Q

Pathogen for Ramsay-Hunt syndrome (What is it?)

A

VZV
(facial nerve palsy due to involvement of CN7 genicular ganglion)

84
Q

Latency region of VZV

85
Q

Vaccine type for VZV

A

Chickenpox: live attenuated vaccine
Zoster: live attenuated / recombinant subunit vaccine

86
Q

Vaccination of VZV for healthcare workers

A

routine VZV IgG check –> if titre declined: 2 doses of chickenpox vaccine

87
Q

Diagnosis of VZV

A

mainly clinical

88
Q

Transmission of EBV (full name?)

A

kissing (saliva), sexual
(Epstein-Barr virus)

89
Q

Latency site of EBV and consequences from reactivation

A

oropharynx, B cells
nasopharyngeal CA, Burkitt lymphoma

90
Q

Early screening for nasopharyngeal CA

A

EBV IgA, EBV DNA
if positive: endoscopy / biopsy

91
Q

Latency site and transmission of CMV

A

salivary glands, kidneys, haemopoietic progenitors
saliva, urine, blood transfusion / transplant / intrauterine

92
Q

Diagnosis of CMV (3)

A

[urine/ saliva] PCR, viral culture
[amniotic fluid] PCR, viral culture
histology from pathological tissue

93
Q

Pathogens for owl eye appearance of cells under histology

94
Q

Treatment for CMV

A

Ganciclovir

95
Q

Which herpes virus can be found in urine?

96
Q

Presentations of HHV6 (primary and reactivation)
Latency site (2) and transmission

A

Primary infection: Roseola infantum
Reactivation: encephalitis
Latency: T lymphocytes, brain
Transmission: Kissing

97
Q

Tumour related to HHV-8

A

Kaposi’s sarcoma (AIDS defining)

98
Q

Pathogens transmitted by Aedes mosquitoes (4)

A

Dengue, Zike, Yellow fever, alpha viruses

99
Q

Pathogens transmitted by Culex mosquitoes (2)

A

JEV, West Nile fever virus

100
Q

Pathogens transmitted by Ticks (3+2)

A

Rickettsia rickettsii, Coxiella burnetii, Borrelia burgdorferi
Tick-borne encephalitis, St Louis encephalitis

101
Q

Pathogens transmitted by mites (2)

A

Orientia tsutsugamushi
Rift valley fever / sandfly fever virus

102
Q

MC arbovirus family (genome)

A

Flaviviridae
(+) ssRNA, enveloped

103
Q

CBC findings in most arbovirus infection

A

↓ WCC, ↓ Plt

104
Q

Arboviruses that cause pan-encephalitis (3)

A

JEV, tick-borne encephlitis virus, St Louis encephalitis virus

105
Q

Arbovirus that causes hepatitis

A

Yellow fever virus

106
Q

Supportive management for arbovirus infection

107
Q

Which 4 arboviruses does HK give vaccination against?

A

Dengue virus, JEV, yellow fever virus, tick-borne encephalitis virus

108
Q

Vector control methods for mosquitoes (3)

A

ovitrap (for vector surveillance)
water hygiene
solid waste management

109
Q

How many serotypes of Dengue virus are there?

110
Q

MC vector for Dengue virus in HK (What type of host is human in the context of Dengue virus?)

A

Aedes albopictus 白紋伊蚊
amplifying host

111
Q

MC vector for JEV in HK (What type of host is human in the cost of JEV?)

A

Culex tritaeniorhynchus
accidental host

112
Q

Molecular mechanisms of viruses to cause cancers in humans
(a) ssRNA
(b) Herpesviridae
(c) other dsDNA / ssRNA-RT

A

(a) chronic inflammation
(b) as episomal gene to produce oncogene
(c) integrate into human genome to express viral oncogene

113
Q

Which pathogen appears as golf ball under EM?

A

Papovaviridae / HPV

114
Q

Which serotypes of HPV cause warts?

115
Q

Which serotypes of HPV have high risk to develop into CA cervix?

116
Q

Carcinogenesis of HPV

A

viral integration –> ↑ E6, E7 –> ↓ p53, pRb

117
Q

3 vaccines for HPV

A

bivalent (16,18), quadrivalent (16,18,6,11), nonavalent

118
Q

Screening for HPV (2)

A

Pap smear for cytology
HPV test

119
Q

Investigations for measles virus

A

Serology for measles IgM
NPA: PCR for viral detection

120
Q

Antigenic drift vs shift

A

Drift: replication error of RNA polymerase, Flu A & B, epidemic
Shift: genetic reassortment btw 2 strains, Flu A, pandemic

MED4 MIC (8 decks)

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