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Micro Mix NBME > Viruses > Flashcards

Viruses Flashcards

1
Q

Herpes virus

A

Enveloped
DS + Linear DNA

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2
Q

Poxvirus

A

Enveloped
DS + Linear (biggest) DNA

Molluscum contagiosum (papule with central umbilication)

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3
Q

Hepadnavirus

A

Enveloped
Partially DS + Circular DNA

HBV (acute or chronic hepatitis, virus has a reverse transcriptase)

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4
Q

Adenovirus

A

DS + Linear DNA

Febrile pharyngitis (sore throat)
Conjunctivitis
Acute hemorrhagic cystitis
Pneumonia
Gastroenteritis
Myocarditis

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5
Q

Papillomavirus

A

DS + Circular DNA

HPV
- Warts (serotypes 1,2,6,11)
- Cancer (cervical, penile, anal etc serotypes 16, 18)

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6
Q

Polyomavirus
“Junky Cerebrum, Bad Kidney”

A

DS + Circular DNA

JC virus (Progressive multifocal leukoencephalitis in HIV)
BK virus (Kidney failure in transplants)

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7
Q

Parvovirus

A

SS + Linear (smallest) DNA

B19
- 5th disease/ Erythema Infectiosum, SCS
- Aplastic crisis in Sickle Cell Disease
- Hydrops fetalis (destroyed RBC precursors)

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8
Q

HSV1

A

Trans via respiratory droplets & saliva

Latent in Trigeminal ganglion

Causes:
Gingivostomatitis
Keratoconjunctivitis
Cold sores
Herpetic whitlow
Temporal lobe encephalitis
Esophagitis
Erythema multiforme

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9
Q

HSV2

A

Trans via sexual contact

Latent in Sacral ganglion

Genital herpes
Neonatal herpes

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10
Q

VZV (varicella zooster virus) HHV3

A

Trans via respiratory droplets & vesicle fluid

Latent in trigeminal or dorsal root ganglion

Chicken pox (all over)
Shingles (one dermatome)
Encephalitis
Pneumonia

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11
Q

EBV (Epstein Barr virus) HHV4

“must be 21 to drink Beer at a Barr”

A

Trans via respiratory droplets & saliva (Kissing disease)

Mononucleosis (monospot +, heterophile +, & Ab agglutination in sheeps blood)
Infects B cells via CD21

Fever hepatosplenomegaly
Pharyngitis
Lymphadenopathy
Nasopharyngeal carcinoma (asians)

Treating with amoxicillin = maculopapular rash

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12
Q

CMV (Cytomegalovirus) HHV 5

A

Trans via sex, urine, transfusions, or congenitally

Mononucleosis-like syndrome (monospot & heterophile -)
in AIDS & transplant patients

OWL eye inclusions & lies latent in mononuclear cells

Esophagitis
Cotton-wool exudates
Vison loss
Congenital CMV

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13
Q

HHV6-7

&

HHV8

A

6-7: picture I
Trans via saliva
Roseola infantum
First fever several days then macular rash (starting at trunk & spreading to arms/legs)

8: picture J
Trans via sex
Kaposi sarcoma in HIV/AIDS & transplant patients (dark/violaceous plaques/nodules)

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14
Q

ID HSV (4)

A

PCR skin lesion

CSF PCR (Herpes encephalitis)

Tzank smear (Multinucleated giant cells)

Intranuclear Cowdry A inclusions

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15
Q

Receptors for:
CMV

A

Integrins (heparan sulfate)

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16
Q

Receptors for:
EBV

A

CD21

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17
Q

Receptors for:
HIV

A

CD4, CXCR4, CCR5

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18
Q

Receptors for:
Parvovirus B19

A

P antigen on RBC’s

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19
Q

Receptors for:
Rabies

A

Nicotinic AChR

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20
Q

Receptors for:
Rhinovirus

A

ICAM 1

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21
Q

Reovirus

A

DS + Linear multisegmented RNA
Icosahedral

Coltivirus (Colorado tick fever)
Rotavirus (Fatal diarrhea in kids)

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22
Q

Picornavirus
“PERCH”

A

SS + Linear RNA
Icosahedral

Poliovirus
Echovirus
Rhinovirus
Coxsackie virus
HAV

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23
Q

Hepevirus

A

SS + Linear RNA
Icosahedral

HEV

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24
Q

Calicivirus

A

SS + Linear
Icosahedral

Norovirus (Viral gastroenteritis)

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25
Q

Flavivirus

A

Enveloped
SS + Linear RNA
Icosahedral

HCV
Yellow fever
Dengue
St. Louis encephalitis
West Nile virus (meningoencephalitis + flaccid paralysis)
Zika

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26
Q

Togavirus
“CREW”

A

Enveloped
SS + Linear RNA
Icosahedral

Chikungunya virus
Rubella
Easter/Western equine encephalitis

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27
Q

Retrovirus

A

Enveloped
SS + Linear (with 2 copies) RNA
Have a reverse transcriptase

Icosahedral (HTLV= T cell leukemia)

Conical (HIV = AIDS)

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28
Q

Coronavirus

A

Enveloped
SS + Linear RNA
Helical

SARS
MERS
Covid 19

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29
Q

Orthomyxovirus

A

Enveloped
SS + Linear RNA in 8 segments
Helical

Influenza

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30
Q

Paramyxoviruses

(childhood viruses)

A

Enveloped
SS + Linear RNA Non-segmented
Helical

Parainfluenza
RSV (Croup)
Measles
Mumps

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31
Q

Rhabdovirus

A

Enveloped
SS - Linear RNA
Helical

Rabies

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32
Q

Filovirus

A

Enveloped
SS - Linear RNA
Helical

EBOLA
Marburg hemorrhagic fever

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33
Q

Arenaviruses

A

Enveloped
SS +/- Circular RNA in 2 segments
Helical

LCMV (Lymphocytic Choriomeningitis virus)
Lassa fever encephalitis (Rodents)

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34
Q

Bunyaviruses

A

Enveloped
SS - Circular RNA in 3 segments
Helical

California encephalitis
Sandfly/Rift valley fever
Crimean-Congo hemorrhagic fever
Hantavirus (hemorrhagic fever & pneumonia)

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35
Q

Deltavirus

A

Enveloped
SS - Circular RNA

HDV (needs HBV to replicate)

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36
Q

Negative stranded viruses

A

Need to transcribe their negative RNA to positive
they bring their own RDRP

Arenavirus

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37
Q

Segmented RNA viruses

“BOARding flight 382 in 10-12 minutes”

A

Bunyavirus (3 segments)
Orthomyxovirus (8 segments)
Arenavirus (2 segments)
Reovirus (10-12 segments)

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38
Q

PircoRNAvirus

“Small RNA viruses PERCH “

A

Poliovirus
Echovirus
Rhinovirus
Coxsackie virus
HAV

All are main causes of Aseptic meningitis

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39
Q

Rhinovirus

A

A picornavirus
NON-Enveloped

100+ Serotypes causing the common cold
Acid labile (can’t infect the GI)

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40
Q

Rotavirus

A

A reovirus
Segmented DS RNA

Infantile gastroenteritis (destroys villi causing less Na absorption and loss of K+) aka diarrhea.

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41
Q

Influenza

A

An orthomyxovirus
Enveloped
SS - RNA with segments

Hemagglutinin (binds sialic acid and lets virus in)
Neuraminidase (prompts progeny release)

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42
Q

Influenza can be superinfected with which 3 viruses

A

S.aureus S. pneumoniae, & H.influenza

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43
Q

Influenza treatment

A

Oseltamivir & Zanamivir
(+/- Neuraminidase inhibitor)

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44
Q

Influenza vaccine

A

Killed and live attenuated (nasal only)

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45
Q

Influenza

Genetic Shift vs Drift

A

Shift:
2 different strains (swine + human) infect the same cell and recombine their RNA to make major changes causing a new variant (can cause PANDEMICS)

Drift:
Random hemagglutinin or neuraminidase protein/gene mutations that cause minor changes to a strain (can cause EPIDEMICS)

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46
Q

Rubella

A

A togavirus

Rubella/German Measles:
Fever, postauricular/lymphadenopathy, arthralgias, fine maculopapular rash (that starts at the face & spreads to the trunk then extremities)

mild in kids
severe congenital

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47
Q

Congenital Rubella

A

A severe TORCH syndrome

Deafness, Cataracts, Patent ductus arteriosus, Blueberry muffin rash appearance

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48
Q

Paramyxoviruses

A

Parainfluenza (croup)
Mumps
Measles
RSV
Human metapneumovirus z

All have F (fusion) surface proteins that cause respiratory epithelium to fuse forming multinucleated cells causing bronchiolitis & pneumonia

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49
Q

Treating Paramyxoviruses

A

Palivizumab (monoclonal antibody against F proteins)

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50
Q

Croup

A

aka acute laryngotracheobronchitis

presents with a seal bark cough & steeple sign on X-RAY

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51
Q

Measles

A

Prodromal fever + cough
Coryza, Conjunctivitis, Koplik spots (bright red spots with blue-white center in mouth)
Lymphadenitis with Warthin-Finkeldey Gian cells

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52
Q

Measles sequelae

A

Subacute sclerosing panencephalitis

Encephalitis

Giant cell pneumonia

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53
Q

Reduces Measles morbidity

A

Vitamin A supplements

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54
Q

Mumps

“mumps make your testes the size of POM PomS”

A

Parotitis
Orchitis
aseptic Meningitis
Pancreatitis
Sterility

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55
Q

Chikungunya virus

A

Togavirus (alphavirus)
Trans via aedes mosquito

Systemic infection (inflammatory polyarthritis, high fever, maculopapular rash, headache, & lymphadenopathy)

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56
Q

Diagnosis test for Chikungunya

A

RT-PCR & Serology

57
Q

Dengue fever

A

Flavivirus
Trans via aedes mosquito

Dengue fever (fever, myalgia, rash, headache, arthralgias, & neutropenia)
Dengue Hemorrhagic fever (Dengue fever & thrombocytopenia)
Dengue Shock ( Circulatory collapse)

58
Q

Dengue fever test & treatment

A

test:
PCR/Serology

Rx. Live recombinant vaccine

59
Q

Rabies

A

Bullet shaped virus
Negri bodies usually in Purkinje cells of cerebellum & hippocampal neurons
Weeks to months IP

It travels to the CNS via retrograde (dynein) after binding ACh receptors causing fever, malaise –> agitation, photo/hydrophobia, & hypersalivation –> Paralysis, coma, & death

60
Q

Treating Rabies

A

Post exposure prophylaxis with killed vaccine & rabies immunoglobin

61
Q

Yellow Fever

A

A flavivirus
Trans via aedes mosquitos

High fever, black vomitus, jaundice, hemorrhages, backaches, & Councilman bodies in the liver

62
Q

Ebola

A

A filovirus
21-day IP period

Abrupt onset of flu symptoms, diarrhea/vomiting, high fever, myalgia, & progressive diffuse hemorrhagic shock

63
Q

Ebola test

A

RT-PCR within 48hrs

64
Q

Zika virus

A

A flavivirus
Trans via aedes mosquito

Conjunctivitis, low-grade pyrexia, & itchy rash

65
Q

Congenital Zika

A

Can end up in miscarriage or congenital Zika.

Ventriculomegaly, Subcortical calcifications, microencephaly, ocular abnormalities, spasticity, & seizures

66
Q

Common symptoms of all Hepatitis infections

A

Naked viruses that cause
Fever, Jaundice, High ALT/AST

67
Q

HAV (Hepatitis A)

A

A picornavirus (RNA)
Trans via fecal-orally (shellfish)

Acute & self limiting (adults)
Asymptomatic (kids)

No hepatocellular carcinoma risk
No carrier state

68
Q

HBV (Hepatitis B)

A

A hepadnavirus (DNA)
Trans via Parentally (Blood/Sex) & Perinatally (Birthing)

Initially like serum sickness (fever, arthralgia, rash, which may progress to carcinoma)

Adults (usually resolves)
Neonates (worse)

High risk of Hepatocellular carcinoma
Common carrier state

69
Q

HBV (Hepatitis B) Liver biopsy shows

A

Granular eosinophilic “ground-glass opacities” that are the accumulation of surface antigens in infected hepatocytes
(CD8 mediated damage)

70
Q

HCV (Hepatitis C)

A

A flavivirus (RNA)
Trans via (Blood, IV drugs, or post transfusions)

May progress to cirrhosis or carcinoma
Majority develop stable chronic hep C

High risk for hepatocellular carcinomas
Carrier state is common

71
Q

HCV (Hepatitis C) Liver Biopsy

A

Lymphoid aggregates with focal areas of macrovesicular steatosis

72
Q

HDV (Hepatitis Delta)

A

A deltavirus (RNA)
Trans via Blood/Sex/Perinatally

Superinfection (HDV after HBV) = short infection

Coinfection (HDV with HBV) = long infection

May progress to cirrhosis or carcinoma

High hepatocellular carcinoma risk
HDV needs HBV’s HBsAg coat to enter hepatocytes

73
Q

HDV (Hepatitis Delta) Liver biopsy

A

Lymphoid aggregates with focal areas of macrovesicular steatosis

74
Q

HEV (Hepatitis E)

A

A hepevirus (RNA)
Trans via Fecal-oral (waterborne)

Fulminant hepatitis in pregnant patients (higher mortality)

No hepatocellular carcinoma risk
No carrier states

75
Q

HEV (Hepatitis E) Liver biopsy

A

Patchy necrosis

76
Q

Extrahepatic manifestations of HBV

A

Aplastic anemia
Membranous Glomerular nephritis
Polyarthritis

77
Q

Extrahepatic manifestations of HCV

A

Essential mixed cryoglobulinemia
High risk of B cell non-Hodkin lymphoma
Autoimmune hemolytic anemia
Membranoproliferative Glomerular nephritis
Leukocytoclastic vasculitis
Sporadic porphyria cutanea tarda
Lichen planus
High risk of diabetes mellitus
Auto immune hypothyroidism

78
Q

Hepatitis serology markers:

Anti-HAV (IgM)

Anti-HAV (IgG)

A

Acute HAV

A prior HAV infection or vaccination (protects against reinfection)

79
Q

Hepatitis serology markers:

HBsAg

Anti-HBs

A

HBV infection

Vaccination or recovery from infection indicates immunity

80
Q

Hepatitis serology markers:

HBc-Ag

Anti-HBc (IgM or IgG)

A

Core HBV

IgM = acute/recent infection
IgG = Chronic/prior infection

81
Q

Hepatitis serology markers:

HbeAg

Anti-HBe

A

Active viral replication + high transmissibility

Low transmissibility

82
Q

Acute HBV infection Serology markers

A

HBsAg
HBeAg
Anti-HBc IgM

83
Q

Window HBV infection Serology markers

A

Anti-HBe
Anti-HBc IgM

84
Q

Chronic with high transmissibility HBV infection Serology markers

A

Anti-HBc IgG
HBeAg
HBsAg

85
Q

Chronic with low transmissibility HBV infection Serology markers

A

Anti-HBc IgG
Anti-HBe
HBsAg

86
Q

Recovery HBV infection Serology markers

A

Anti-HBc IgG
Anti-HBs
Anti-HBe

87
Q

Immunized HBV infection Serology markers

A

Anti-HBs

88
Q

HIV 3 structural genes

A

env:
gb120 (attaches to host CD4 + Tcell)
gb41 (fusion + entry)

gag:
p24 (capsid protein)
p17 (matrix protein)

pol:
Reverse transcriptase (makes DS DNA from RNA)
Integrase (DS DNA is integrated into host’s genome)
Protease (Virus binds CD4 & a coreceptor either CCR5 (Macrophages in early inf) or CXCR4 (T cells in late inf)

Homozygous CCR5 = Immune
Heterozygous CCR5 = Slower disease course

89
Q

Diagnosing HIV

A

HIV 1/2 Ag/Ab immunoassay
Detecting P24 Ag capsid protein & IgG Abs to HIV 1/2

90
Q

AIDs Defining conditions:

CD4 <500

A

Candida albicans (oral thrush, a scrapable white plaque with pseudohypae on microscopy)

EBV (Oral hairy leukoplakia, an Un scrapable white plaque on tongue)

HHV8 (Kaposi sarcoma, perivascular spindle cells invading & forming vascular tumors)

HPV (Squamous cell carcinoma)

91
Q

AIDs Defining conditions:

CD4 <200

A

Histoplasma (fever, weight loss, fatigue, cough, dyspnea, nausea, vomiting, & diarrhea, oval yeast cells in macrophages)

HIV (Dementia, cerebral atrophy)

JC virus (Progressive multifocal leukoencephalopathy, non-enhancing areas of focal demyelination on MRI)

Pneumocystis jirovecii (Pneumocystis pneumonia with ground-glass opacities on chest imaging)

92
Q

AIDs Defining conditions:

CD4 <100

A

Aspergillus fumigatus (Hemoptysis, pleuritic pain, with cavitation on infiltrates on chest imaging)

Bartonella spp (Bacillary angiomatosis, Mutiple red-purple papules/nodules, biopsy with neutrophilic inflammation)

Candida albicans (esophagitis, white plaques on endoscopy with yeast + pseudohyphae on biopsy)

CMV (Colitis, Retinitis, Esophagitis, Encephalitis, Pneumonitis with Linear ulcers on endoscopy, cotton-wool spots on fundoscopy, & owl eye inclusions in biopsy)

Cryptococcus neoformans (Meningitis, with encapsulated yeast on Indian ink stain or capsular Ag +)

Cryptpsporidium spp (Chronic watery diarrhea with acid fast oocysts in stool)

EBV (B cell lymphoma showing ring enhancing lesions)

Mycobaterium avium intracellulare & complex (fever, night-sweats, weight loss or focal lymphadenitis, & risk of toxoplasma gondii infection)

93
Q

Prion diseases are due to

A

A mutation causing a helix PrPc to convert to B-pleated PrPsc, which accumulate in CNS causing spongiform encephalitis, dementia, & ataxia

93
Q

CJD (Creutzfeldt-Jakob disease)

A

Spongiform encephalopathy causing rapidly progressive dementia

94
Q

BSE

A

Bovine Spongiform encephalopathy aka Mad cow disease

95
Q

Kuru

A

Acquired prion disease noted in tribes that practice cannibalism

96
Q

Normal dominant flora:

Skin
Nose
Oropharynx
Dental plaque
Colon
Vagina

A

Skin = S. epidermidis
Nose = S. epidermidis, colonized s. aureus
Oropharynx = Viridians group streptococci
Dental plaque = S. mutans
Colon = B. fragilis + E.coli
Vagina = Lactobacillus, colonized E.coli + group B streptococci

97
Q

Bacillus cereus infection is from

A

Re-heated rice

98
Q

C. botulinum infection is from

A

Improperly canned food (toxins) or raw honey (spores)

99
Q

C. perfringes infection is from

A

Re-heated meat

100
Q

E.coli 0157:H7

A

Undercooked meat

101
Q

L. monocytogenes

A

Deli meats + soft cheese

102
Q

Salmonella

A

Poultry + eggs

103
Q

S. aureus

A

Meat, mayo, custard, preformed toxin

104
Q

V. parahaemolyticus & V. vulnificus

A

Raw/undercooked seafood

105
Q

Major causes of bloody diarrhea (infections)

A

Campylobacter
E. histolytica
Enterohemorrhagic E.coli
Enteroinvasive E.coli
Salmonella (non-typhi)
Shigella
Y enterocolitica

106
Q

Major causes of watery diarrhea (infections)

A

C. difficile
C. perfringes
Enterotoxigenic E.coli
Giardia
Cryptosporidium
V. cholerae
Norovirus
Rotavirus
Enteric adenovirus

107
Q

Major causes of pneumonia (infections):

Neonates

Children

A

N:
Group B streptococci
E.coli

C:
RSV
Mycoplasma
C. trachomatis
C. pneumoniae
S. pneumoniae

108
Q

Major causes of pneumonia (infections):

Adults

Elderly

A

A:
Mycoplasma
C. pneumoniae
H. influenza
Anaerobes

E:
S. pneumoniae
Influenza
Anaerobes
Gram neg rods

109
Q

Common infections with Alcohol use

A

Klebsiella
Anaerobes

110
Q

Common infections with IV drugs

A

S. pneumoniae
S. aureus

111
Q

Common infections causing meningitis

A

S. agalatiae
E.coli
Listeria monocytogenes

112
Q

Bacterial CSF

A

High opening pressure
Elevated PMN cells
Elevated proteins
Low glucose

113
Q

Fungal/TB CSF

A

High opening pressure
Elevated lymphocytes
Elevated proteins
Low glucose

114
Q

Viral CSF

A

Normal or high opening pressure
Elevated lymphocytes
Normal or high proteins
Normal glucose

115
Q

Bacterial vaginosis

A

Gardnerella vaginalis
No inflammation & thin white discharge with a fishy smell
Clue cells
Positive KOH Whiff test
Lower pH (below 4.5)

116
Q

Treat Gardnerella vaginalis

A

Metronidazole or clindamycin

117
Q

Trichomonas vaginitis

A

Inflammation (Strawberry cervix)
Frothy, yellow-green, & foul-smelling discharge
Motile pear-shaped trichomonads
Low pH (below 4.5)

118
Q

Treat Trichomonas vaginitis

A

Metronidazole

119
Q

Candida albicans

A

Inflammation
Thick-white “cottage-cheese” discharge
Pseudohyphae
Normal pH (4-4.5)

120
Q

Treating Candida albicans

A

Azoles

121
Q

TORCH

Toxoplasma gondii

A

Trans via cat poop or undercooked pork

Neonates:
chorioretinitis
hydrocephalus
intracranial calcifications
Blueberry muffin rash

122
Q

TORCH

Rubella

A

Trans via respiratory droplets

Mom:
Rash, lymphadenopathy, pharyngitis, polyarthritis

Neonate:
Cataracts, deafness, congenital heart disease, Blueberry muffin rash

123
Q

TORCH

CMV (Cytomegalovirus)

A

Trans via sex/transplants

Mom: Asymptomatic or mononucleosis-like illness

Neonate: Hearing loss, seizures, Blueberry muffin rash, chorioretinitis, periventricular calcifications

124
Q

TORCH

HIV

A

Trans Sex/needle stick

Mom= variable

Neonate= Recurrent infections & chronic diarrhea

125
Q

TORCH

Herpes Simplex Virus 2

A

Trans Skin/mucous membranes

Mom: Genital herpes

Neonate: Meningoencephalitis, herpetic vesicular lesions

126
Q

TORCH

Syphilis

A

Trans Sex

Mom: Chancre & disseminated rash

Neonate:
Death via still birth or hydrops fetalis
Survived causes facial defects, saber shins, & VIII deafness

127
Q

VZV (Varicella Zooster virus)

A

Chicken pox (Vesicular rash starts on the trunk & spreads to face/extremities with lesions at different stages)

128
Q

Coxsackie A

A

Hand-foot-mouth disease (Oval-shaped vesicles on palms/soles; with vesicles + ulcers in the oral mucosal (herpangina))

129
Q

HHV6

A

Roseola (exanthem subitum)

Asymptomatic rose colored macules on the body after a several day long fever with febrile seizures (usually infants)

130
Q

Measles virus (Rubeola)

A

Confluent rash (starts at the head & moves down) then cough, coryza, conjunctivitis, & Koplik spots (blue-white spots on the mouth mucosa)

131
Q

Parvovirus B19

A

Erythema infectious (5th disease) slapped cheek syndrome on the face.
&
Hydrops fetalis in pregnant patients

132
Q

Rubella virus

A

Rubella (pink macules & papules (that start at the head and move down as a fine desquamating truncal rash, & post auricular lymphadenopathy)

133
Q

Streptococcus pyogenes “SCARLET”

A

Scarlet fever”
Sore throat
Circumoral pallor
group A streptococci
Rash
Lymphadenopathy
Erythrogenic toxin
strawberry Tongue

134
Q

Sexually transmitted infections:

HIV

A

AIDS (Opportunistic infections, Kaposi’s sarcoma, & lymphoma)

135
Q

Sexually transmitted infections:

Haemophilus ducreyi
(do cry)

A

Chancroid (a painful genital ulcer with exudate & inguinal adenopathy)

136
Q

Chlamydia trachomatis (D-K)

A

Chlamydia (urethritis, cervicitis, epididymitis, conjunctivitis, reactive arthritis, & PID)

137
Q
A

Micro Mix NBME (2 decks)

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