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NBME Micro > Viruses: DNA Viruses > Flashcards

Viruses: DNA Viruses Flashcards

1
Q

List the DNA viruses

A
  1. Herpes simplex virus 1
  2. Herpes simplex virus 2
  3. Epstein-Barr Virus
  4. Cytomegalovirus
  5. Varicella-zoster virus
  6. HHV-6
  7. Roseola
  8. HHV-8
  9. Kaposi’s Sarcoma
  10. JC polyomavirus
  11. BK polyomavirus
  12. Human papillomavirus
  13. Parvovirus
  14. Adenovirus
  15. Smallpox virus
  16. Cowpox virus
  17. Molluscum
  18. contagisum virus
  19. Hepatitis B virus
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2
Q

herpes simplex virus type 1 & 2

A
  1. DNA viruses
  2. Herpesviridae family
  3. enveloped
  4. double stranded DNA
  5. Linear DNA
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3
Q

Cowdry bodies

A

Cowdry bodies are eosinophilic intranuclear inclusions that can be found in cells infected with HSV (as well as CMV and VZV)

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4
Q

HSV-1 and HSV-2 can be transmitted

A

vertically

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5
Q

HSV-1 and HSV-2 are

A

TORCHeS infection

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6
Q

the initial outbreak of HSV-1 often presents as

A

gingivostomatitis (vesicular lesions and ulcerations of the oral cavity and perioral area)

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7
Q

herpes labialis (or cold sores) presents

A

on the lips and is typically caused by HSV-1

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8
Q

keratoconjunctivitis caused by HSV (typically type 1) presents with

A

serpiginous corneal ulcers seen on fluorescein slit lamp exam

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9
Q

HSV (typically type 1) can cause

A

hemorrhagic temporal lobe encephalitis

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10
Q

HSV-1 is the number one cause of

A

sporadic encephalitis in the US

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11
Q

HSV (typically type 1) lies dormant in

A

trigeminal ganglia

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12
Q

HSV lesions have

A

a “dew drop on a rose petal” appearance

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13
Q

herpetic whitlow

A

is caused by HSV and is characterized by painful lesions on one or more fingers (herpetic whitlow is more common in dentists)

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14
Q

erythema multiforme

A

erythema multiforme is a hypersensitivity reaction associated with certain infections (such as HSV) that presents with small target lesions on the back of the hands and feet and move centrally

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15
Q

painful inguinal lymphadenopathy is associated with

A

HSV (typically type 2)

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16
Q

HSV (typically type 2) lies dormant in the

A

sacral ganglia

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17
Q

HSV (typically type 2) can lead to

A

aseptic meningitis in both adolescents and adults

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18
Q

a Tzanck smear can be used to visualize

A

multinucleated giant cells infected with HSV, which aids in diagnosis

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19
Q

_____ can be used to prevent HSV breakouts

A

valacyclovir or acyclovir

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20
Q

Epstein-Barr virus

A

a DNA virus in the Herpesviridae family

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21
Q

Epstein-Barr virus is primarily transmitted through

A

saliva

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22
Q

_____ is one of the classic features of Epstein-Barr virus-induced mononucleosis

A
  1. fever

2. painful lymphadenopathy in the posterior cervical region

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23
Q

Epstein-Barr virus infection causes

A

peripheral lymphocytosis and the presence of atypical lymphocytes (abnormally large reactive CD8+ T-cells with abundant cytoplasm) and Downey cells (atypical lymphocytes with strongly basophilic cytoplasm pathognomonic of EBV infection)

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24
Q

T-cell proliferation in response to Epstein-Barr virus infection can result in

A

splenomegaly and enlarged lymph nodes (splenomegaly is one of the classic features of EBV-induced mononucleosis)

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25
Q

Epstein-Barr virus remains latent in

A

B-Cells

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26
Q

to initiate infection, the Epstein-Barr virus

A

envelope glycoprotein binds to the CD21 membrane protein of B-cells

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27
Q

pharyngitis with production of tonsillar exudate is a common feature of

A

Epstein-Barr virus-induced mononucleosis

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28
Q

patients with Epstein-Barr virus infections who are mistakenly treated with penicillin or amoxicillin (due to suspicion of streptococcal pharyngitis) can develop a

A

maculopapular rash

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29
Q

Epstein-Barr virus infection is associated with a higher risk for development of

A
  1. some cancers, including Hodgkin’s and non-Hodgkin’s lymphoma and Burkitt lymphoma (B-cell cancers)
  2. nasopharyngeal carcinoma, which is more commonly seen in patients with Asian ancestry
  3. oral hairy leukoplakia, which occurs most commonly in HIV patients
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30
Q

Epstein-Barr virus infection may be associated with the development of

A

Hodgkin’s lymphoma, which is characterized by Reed-Sternberg cells (classically described as having an “owl eye” appearance)

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31
Q

African (or endemic) Burkitt lymphoma (sometimes associated with Epstein-Barr virus infection) often presents with

A

a large jaw lesion and jaw swelling

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32
Q

the monospot test

A

can be useful to rapidly diagnose acute Epstein-Barr virus infection; the monospot test utilizes horse or sheep RBCs, which will agglutinate when mixed with patient serum due to production of anti-horse/sheep blood IgM antibodies induced by the presence of Epstein-Barr virus

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33
Q

patients with infectious mononucleosis should avoid

A

contact sports due to risk of splenic rupture

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34
Q

Cytomegalovirus

A

a DNA virus in the Herpesviridae family

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35
Q

Cytomegalovirus can remain latent in

A
  1. mononuclear white blood cells (i.e. lymphocytes, monocytes, and macrophages)
  2. B-Cells and T-Cells
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36
Q

Cytomegalovirus can reactivate and

A

cause disease, most commonly in immunosuppressed patients

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37
Q

Cytomegalovirus can be transmitted

A

vertically and is a TORCHeS infection (Cytomegalovirus is the “C” in “TORCHeS”)

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38
Q

congenital cytomegalovirus infection can present with

A
  1. a characteristic “blueberry muffin” rash
  2. jaundice
  3. Hepatosplenomgealy
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39
Q

congenital cytomegalovirus infection is a cause of

A

bilateral or unilateral sensorineural hearing loss

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40
Q

congenital cytomegalovirus infection can result in structural abnormalities in the brain, including

A
  1. ventriculomegaly

2. intracranial (predominantly periventricular) calcifications

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41
Q

the changes in brain structure caused by congenital cytomegalovirus infection can lead to

A

developmental delay and/or seizures

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42
Q

80-90% of newborns with congenital cytomegalovirus infection are

A

asymptomatic

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43
Q

intrauterine Cytomegalovirus infection can result in

A

hydrops fetalis, which is characterized by fluid accumulation in multiple compartments of the fetus

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44
Q

Cytomegalovirus is the number one cause of

A

sensorineural hearing loss in children and the number one congenital viral infection

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45
Q

Cytomegalovirus is associated with

A

organ transplantation

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46
Q

transplant patients are at risk for developing

A

Cytomegalovirus pneumonia (as well as other CMV infections, including hepatitis, gastritis and colitis, and encephalitis)

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47
Q

immunocompromised patients (i.e. HIV patients) are at a higher risk for

A

Cytomegalovirus infection

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48
Q

patients with a CD4+ count <50 are at an especially high risk for

A

Cytomegalovirus infection and should be given antivirals prophylactically

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49
Q

a common manifestation of Cytomegalovirus infection in AIDS patients is

A

CMV retinitis, which is sometimes described as “pizza pie” retinopathy

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50
Q

Cytomegalovirus is a common cause of

A

HIV-associated esophagitis and is likely to present with singular, deep, and linear esophageal ulcerations

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51
Q

Cytomegalovirus colitis is likely to present with

A

ulcerations on the walls of the colon

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52
Q

“owl’s eye” inclusions can be seen upon microscopic examination of

A

Cytomegalovirus infected cells

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53
Q

Cytomegalovirus lines with the UL97 gene mutation require treatment with

A

foscarnet (the UL97 gene mutation confers resistance to ganciclovir)

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54
Q

Cytomegalovirus infection often presents with

A

sore throat, lymphadenopathy, and fatigue (symptoms are similar to those seen in EBV infection)

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55
Q

a monospot test can be performed to

A

differentiate Cytomegalovirus from EBV infection; the monospot test in Cytomegalovirus infection will be negative

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56
Q

_______ is effective against Cytomegalovirus strains without the UL97 gene mutation

A

gangciclovir

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57
Q

varicella-zoster virus

A
  1. a DNA virus in the Herpesviridae family

2. enveloped

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58
Q

varicella-zoster virus causes

A

chickenpox (a pruritic rash with small, fluid-filled blisters)

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59
Q

chickenpox may present with

A

fever (often before development of lesions)

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60
Q

headache is a common symptom of

A

chickenpox

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61
Q

varicella-zoster virus is transmitted via

A

respiratory droplets

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62
Q

the vesicular lesions caused by varicella-zoster virus are classically described as

A

“dew drops on a rose petal”

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63
Q

the vesicular lesions of chickenpox are typically found in

A

various stages of development and healing

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64
Q

__________ can be used to visualize multinucleated giant cells infected with varicella-zoster virus, which aids in diagnosis

A

a Tzanck smear

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65
Q

patients who contract varicella-zoster virus in adulthood have a higher likelihood of developing

A

pnuemonia

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66
Q

a major complication of varicella-zoster virus infection is

A

encephalitis

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67
Q

immunocompromised patients are at a higher risk of developing

A

varicella pneumonia or encephalitis

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68
Q

the vaccine for varicella-zoster virus is a

A

live attenuated vaccine typically administered in childhood

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69
Q

________ is effective against varicella-zoster virus infection in children ages 12+, adults, and immunocompromised patients

A

acyclovir

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70
Q

varicella-zoster virus remains latent in

A

dorsal root ganglia

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71
Q

reactivation of varicella-zoster virus occurs with

A

stress, aging, or immunosuppression

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72
Q

the reactivated form of varicella-zoster virus is called

A

shingles (or herpes zoster); shingles more commonly affects the elderly or immunocompromised

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73
Q

shingles (or herpes zoster) presents with a

A

“dew drop on a rose petal” appearing rash within a dermatomal distribution

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74
Q

shingles (or herpes zoster) is typically

A

extremely painful

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75
Q

postherpetic neuralgia is a complication of

A

shingles, which presents as burning pain in the nerve fibers and skin long after the shingles rash has cleared

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76
Q

herpes zoster ophthalmicus develops when

A

varicella-zoster virus reactivates in V1 (the ophthalmic division of the trigeminal nerve), and can lead to vision loss

77
Q

the live attenuated varicella-zoster vaccine is recommended for adults over

A

60

78
Q

HIV patients with a CD4+ count of >200 may receive the

A

varicella-zoster vaccine

79
Q

________ is effective against varicella-zoster shingles infection

A
  1. famciclovir

2. valacyclovir

80
Q

varicella-zoster virus can be transmitted

A

vertically and is a TORCHeS infection (varicella-zoster virus falls in the “other” category of “TORCHeS”)

81
Q

congenital varicella syndrome

A

can develop if varicella-zoster virus is contracted during the first two trimesters of pregnancy and can result in cutaneous dermatomal scarring, blindness, and limb hypoplasia

82
Q

HHV-6

A

a DNA virus in the Herpesviridae family

83
Q

roseola

A

roseola (also known as sixth disease or exanthem subitum) is caused by HHV-6

84
Q

HHV-6 infects

A

CD4+ helper T-cells, which can lead to immunosuppression

85
Q

HHV-6 is a

A

DNA virus in the Herpesviridae family

86
Q

roseola is characterized by

A

a fever generally lasting 4 days

87
Q

children with roseola can develop

A

febrile seizures

88
Q

roseola can present with

A

a diffuse, lacy body rash that spares the face (the rash typically presents after fever has subsided)

89
Q

roseola affects children ages

A

6 months to 2 years and is usually self-limiting

90
Q

HHV-8

A

a DNA virus in the Herpesviridae family

91
Q

HHV-8 is a DNA virus in the Herpesviridae family and causes

A

Kaposi sarcoma

92
Q

Kaposi sarcoma

A

(caused by HHV-8) is an AIDS-defining illness

93
Q

Kaposi sarcoma is characterized by

A

violaceous lesions on the nose, extremities, and mucous membranes

94
Q

Kaposi sarcoma causes

A

vascular proliferation

95
Q

HHV-8 dysregulates

A

vascular endothelial growth factor (VEGF), leading to aberrant angiogenesis

96
Q

Kaposi sarcoma lesions can be found within

A

the GI tract

97
Q

Kaposi sarcoma lesions most commonly occur on

A

the hard palate

98
Q

HHV-8 can infect

A

B-cells, which may result in primary effusion lymphoma (a B-cell lymphoma)

99
Q

HHV-8 is endemic to

A

areas of Africa

100
Q

Kaposi sarcoma lesions

A

Kaposi sarcoma lesions have a similar appearance to bacillary angiomatosis (caused by Bartonella henselae) and differentiation requires microscopic examination of tissue (Kaposi sarcoma lesions have lymphocytic infiltrate)

101
Q

Polyomaviruses include

A
  1. JC Virus

2. BK virus

102
Q

Polyomaviruses are

A
  1. circular, double-stranded DNA viruses

2. naked viruses

103
Q

JC virus

A

(or John Cunningham virus) (a DNA virus in the Polyomaviridae family)

104
Q

the JC virus can cause

A

progressive multifocal leukoencephalopathy

105
Q

JC virus more commonly affects

A

immunocompromised patients and is known to reactivate in HIV or immunosuppressed states

106
Q

JC virus affects (or can reactivate in) HIV patients with a

A

CD4+ count <200

107
Q

JC virus has a

A

higher incidence of infection in HIV patients

108
Q

progressive multifocal leukoencephalopathy (caused by JC virus) is characterized by

A

non-enhancing multifocal brain lesions in white matter

109
Q

progressive multifocal leukoencephalopathy (caused by JC virus) is a

A

demyelinating disease

110
Q

BK virus

A

a DNA virus in the Polyomaviridae family

111
Q

BK virus infection can lead to

A

nephropathy (typically following organ transplantation and immunosuppression, when a latent infection reactivates)

112
Q

BK virus infection can cause

A

hemorrhagic cystitis in immunocompromised patients

113
Q

BK virus nephropathy typically occurs following

A

organ transplantation (particularly kidney and bone marrow transplants)

114
Q

human papillomavirus

A
  1. a DNA virus in the Papillomaviridae family

2. naked virus

115
Q

HPV serotypes 1-4

A

DNA viruses in the Papillomaviridae family associated with verruca vulgaris

116
Q

common cutaneous warts (caused by HPV serotypes 1-4) often appear on

A

the hands and feet of children

117
Q

transmission of cutaneous common warts (caused by HPV serotypes 1-4) requires

A

physical contact

118
Q

HPV serotypes 6 and 11

A

DNA viruses in the Papillomaviridae family associated with laryngeal papillomatosis and anogenital warts

119
Q

HPV serotypes 6 and 11 can cause

A
  1. laryngeal papillomatosis

2. anogenital warts (condyloma acuminata), which are sexually transmitted

120
Q

condyloma acuminata (anogenital warts) are most frequently caused by

A

HPV serotypes 6 and 11

121
Q

HPV serotype 16

A

a DNA virus in the Papillomaviridae family associated with cancer

122
Q

HPV serotype 18

A

a DNA virus in the Papillomaviridae family associated with cancer

123
Q

HPV serotypes 16, 18, 31, and 33 are known to cause

A

many anogenital and squamous cell cancers (including cervical, vulvar, vaginal, penile, and anal carcinomas)

124
Q

HPV is primarily transmitted via

A

sexual contact

125
Q

HPV can cause

A

squamous cell carcinoma, which often manifests in the anogenital region

126
Q

Gardasil

A

Gardasil (an inactivated subunit vaccine) provides protection against HPV serotypes 6, 11, 16, and 18

127
Q

Gardasil covers

A

HPV serotypes 6, 11, 16, and 18 (but not 1-4)

128
Q

the p53 tumor suppressor protein

A

(which can inhibit progression from the G1 to S phase during mitosis) is destroyed by HPV’s E6 protein, leading to unchecked cell replication

129
Q

the p53 tumor suppressor protein is a

A

checkpoint protein that can inhibit progression from the G1 to S phase during mitosis

130
Q

the Rb tumor suppressor protein

A

(which can inhibit progression from the G1 to S phase during mitosis) is destroyed by HPV’s E7 protein, leading to unchecked cell replication

131
Q

Pap smears

A

detect early signs of cervical cancer caused by HPV

132
Q

koilocytes

A

(HPV-infected cells from the transformation zone) undergo morphological changes that cause cells to appear large and dense with a wrinkled nucleus (often binucleated)

133
Q

HIV infection may enhance the expression of

A

HPV proteins E6 and E7

134
Q

immunosuppression is a risk factor for the development of

A

cervical cancer caused by HPV

135
Q

parvovirus B19

A
  1. a DNA virus in the Parvoviridae family
  2. naked virus
  3. smallest DNA virus
  4. single stranded DNA virus
136
Q

parvovirus B19 is transmitted via

A

respiratory droplets

137
Q

parvovirus B19 can be transmitted

A

vertically and is a TORCHeS infection (parvovirus falls in the “other” category of “TORCHeS”)

138
Q

parvovirus B19 causes

A
  1. slapped cheek syndrome (also called fifth disease or erythema infectiosum)
  2. arthralgias, arthritis, and generalized edema in adults
  3. transient aplastic crisis in sickle cell patients
139
Q

the rash caused by parvovirus B19 starts on the

A

face and spreads inferiorly

140
Q

hydrops fetalis can occur with

A

fetal parvovirus B19 infection

141
Q

adenovirus

A
  1. a DNA virus in the Adenoviridae family

2. naked virus

142
Q

adenovirus is the most common cause of infection in the

A

adenoids and tonsils

143
Q

adenovirus infection can cause

A
  1. tonsillitis
  2. hemorrhagic cystitis
  3. viral conjunctivitis (pink eye)
144
Q

adenovirus can be transmitted via

A
  1. respiratory droplets

2. fecal orally

145
Q

_______ are commonly affected by adenovirus

A

children

146
Q

adenovirus is often spread via

A

public swimming pools

147
Q

outbreaks of adenovirus are known to occur in

A

military barracks

148
Q

military recruits may be administered a live vaccine to prevent

A

adenovirus infection

149
Q

the adenovirus vaccine is a

A

live vaccine

150
Q

poxviruses include

A
  1. smallpox
  2. cowpox
  3. molluscum contagiosum
151
Q

poxviruses

A
  1. DNA viruses
  2. make their own envelope
  3. encode their own DNA-dependent RNA polymerase, which allows them to replicate in the cytoplasm of host cells
  4. replicate outside of the nucleus
  5. have a dumbbell shaped core
  6. largest known DNA viruses
152
Q

Guarnieri bodies (inclusion bodies) are the sites of poxvirus (i.e. smallpox virus, Cowpox virus, Molluscum contagiosum virus)

A

replication in the cytoplasm of host cells

153
Q

smallpox virus

A

smallpox virus (or Variola virus, a DNA virus in the Poxviridae family)

154
Q

smallpox virus lesions

A

smallpox virus lesions develop at the same rate, which helps distinguish them from varicella (or chickenpox) virus lesions

155
Q

Cowpox virus

A

a DNA virus in the Poxviridae family

156
Q

cowpox is contracted via

A

contact with infected cow udders

157
Q

Molluscum contagiosum virus

A

a DNA virus in the Poxviridae family

158
Q

the poxvirus family includes the Molluscum contagiosum virus, which causesincludes

A

flesh-colored, dome-shaped, umbilicated skin lesions

159
Q

molluscum contagiosum presents with

A

umbilicated lesions on the trunk in children

160
Q

adults with diffuse molloscum contagiousum lesions suggests

A

immunosuppression (i.e. HIV patients)

161
Q

Hepatitis B virus

A
  1. a DNA virus in the Hepadnaviridae family
  2. enveloped virus
  3. partially double stranded DNA virus
162
Q

Hepatitis B virus is a cause of

A

hepatitis

163
Q

Hepatitis B virus undergoes

A

both intranuclear and cytoplasmic replication

164
Q

the reverse transcriptase of Hepatitis B virus is

A

an RNA-dependent DNA polymerase, which converts RNA to DNA

165
Q

Hepatitis B virus is transmitted via

A
  1. sexual contact and blood products (IV drug use, needlesticks, or transfusions)
  2. vertically during delivery from mixing of maternal and fetal blood
166
Q

hepatitis B is considered a

A

TORCHeS infection (Hepatitis B virus falls in the “other” category of “TORCHeS”)

167
Q

90% of neonatal Hepatitis B virus infections progress to

A

chronic infections

168
Q

10% of Hepatitis B virus infections among adults progress to

A

chronic infections

169
Q

Hepatitis B virus infection can lead to

A
  1. polyarteritis nodosa (PAN), a form of chronic vasculitis
  2. arthralgias
  3. chronic kidney disease
  4. cirrhosis
170
Q

Hepatitis B virus infection can present with

A

rash

171
Q

Hepatitis B virus infection is associated with

A
  1. membranous glomerulopathy

2. membranoproliferative glomerulonephritis

172
Q

ALT and Hep B

A

ALT rises during an acute Hepatitis B virus infection and falls when the symptomatic phase is over; in viral hepatitis, ALT>AST

173
Q

ALT levels are often ______ in neonatal hepatitis B

A

normal

174
Q

HBsAg

A

HBsAg (hepatitis B surface antigen) is the first serological marker of an active Hepatitis B virus infection

175
Q

HBeAg

A

(hepatitis B envelope antigen) is an indicator of active viral replication and is a sign of high infectivity

176
Q

during the symptomatic phase of Hepatitis B virus infection, patients will be positive for

A

HBsAg and HBeAg (hepatitis B surface and envelope antigens)

177
Q

anti-HBc IgM

A

anti-HBc IgM (hepatitis B core antibodies) is the first detectable antibody, which may be the only detectable serological marker during the window period (when hepatitis B viral antigens (HBsAG and HBeAg) are no longer present and subsequent antibodies have yet to develop)

178
Q

the presence of anti-HBe (hepatitis B envelope antibodies) is indicative of

A

low transmissibility

179
Q

the presence of anti-HBs (hepatitis B surface antibodies) is indicative of

A

recovery from infection or previous immunization

180
Q

patients who have received the hepatitis B vaccine will test positive for

A

patients who have received the hepatitis B vaccine will test positive for anti-HBs (surface antibodies), and negative for anti-HBc and anti-HBe (hepatitis B core and envelope antibodies)

181
Q

Hepatitis B virus infection is a risk factor for

A

hepatocellular carcinoma

182
Q

hepatitis D virus

A
  1. a negative-sense RNA virus that propagates only in the presence of Hepatitis B virus
  2. enveloped
  3. circular single stranded RNA virus
183
Q

hepatitis D virus requires

A

HBsAg (hepatitis B surface antigen) to be infectious

184
Q

co-infection occurs when both hepatitis D virus and Hepatitis B virus are transmitted

A

simultaneously

185
Q

superinfection occurs when

A

superinfection occurs when hepatitis D virus infection is contracted by a patient with preexisting chronic hepatitis B

186
Q

Hepatitis B virus and hepatitis D virus superinfection is associated with

A

a worse prognosis

187
Q

_______ is effective against Hepatitis B virus

A
  1. iamivudine
  2. NRTIs
  3. interferon alpha
188
Q

NRTIs

A

NRTIs (nucleoside reverse transcriptase inhibitors) are effective against Hepatitis B virus

189
Q

at risk infants should be given hepatitis B immune globulin (HBIG) along with

A

passive vaccination

NBME Micro (36 decks)

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