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Week 1 - Day 5 notes


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What is Reye's Syndrome?
Children with the flu or chicken pox when given aspirin - may develop liver and brain disease.
when was the last case of smallpox
Name the 3 members of the Papovaviridae
1. Papillomavirus
2. Polyomavirus - 2 members BK and JC virus
3. Simian VAcuolating virus
Guess your USMLE score? 240?
Yeah right
Name the two DNA virus with a circular dsDNA?
Hepadnavirus(partial circular) and PapOvavirus
Which is the largest DNA virus?
Pox - (small pox, cow pox, molluscum contgiosum)
what are the features of PICORNAvirus:
Positive sense
RNA virus
RNA viruses: negative stranded
"Always Bring Polymerase Or Fail Replication":
Arena -LCV:Lymphocytic choriomeningitis (mice)
Bunya - Cali encephalitis,Hantavirus,Rift valley fevers, Congo hemorrhagic fever
Filo - Ebola
Rhabdo - Rabies
· Note: Negative RNA viruses need there own polymerase
Teratogens: placenta-crossing organisms
· Alternatively: TORCHES: with Others (parvo, listeria), Enteroviruses
RNA enveloped viruses
FORT ABC, Puerto Rico:
Flavivirus/ Filo
There are only 3 RNA viruses that dont have envelopes?
my convertible Small(pico) REO's trip to CALI?
Only ----- viruses have helical symmetry capsids
Name the six DNA viruses
Herpes, Hepadna, Adeno, Papova, Parvo, Pox
Most DNA viruses are double stranded except for ----. [it's a kid]
Most DNA viruses have icosahedral symmetry except ---, which looks like a box.
pox in a box
Which three DNA viruses are naked?
papova, adeno, parvo (a woman must be naked for a PAP smear)
Which three DNA viruses have envelopes?
Herpes, hepadna, pox
Only RNA virus that is double stranded.
Reovirus. "repeato virus"
DNA viruses replicate in the ----, while RNA viruses replicate in the ----.
nucleus. Cytoplasm
Nonenveloped RNA viruses
picorna, calici, reoviridae
Five with icosahedral symmetry (the others are helical)s
reo, picorna, toga, flavi, calici
Two RNA viruses that undergo replication in the nucleus
Retro and orthomyxo
The late genes of DNA viruses are transcribed from the DNA of -----
Structural components are encoded by ----- genes.
Orthomyxoviridae are spherical virions that have segmented ---- stranded RNA.
Hemagluttinin attaches to host sialic acid receptors on RBCs, causing agglutination, and on cell membranes of the cells of the ----- ------- ------. What bacterium has filamentous hemagluttinin which it uses to attach to the same area as orthomyxoviridae
upper respiratory tract. B. pertussis
Neuraminidase cleaves neuraminic acid, which is an important component of -----.
Antigenic shift can only occur in influenza type ----. Why?
type A is the only one that can also infect animals. The shift requires co-infection and mixed-up packaging
A complication of the flu in elderly.
viral pneumonia (spread to lower respiratory tract) --> bacterial pneumonia (staph, pneumococcus)
New one hour test that helps to guide the choice of antiviral agents.
detection of viral proteins
Drugs that prevent uncoating of influenza A.
amantadine, rimantadine
Paramyxoviridae differ from orthomyxo in that the negative strand of RNA is not ------
Paramyxoviridae possess ----- ----- which allows infected cells to fuse together.
F protein
Paramyxoviridae infect the (upper/lower) respiratory tract of children, while the opposite is true in adults.
lower Resp tract in children
Parainfluenza infection of the larynx. Think Anne of Green Gables.
Number one cause of pneumonia in babies < 6mo
Respiratory Syncytial virus
IN the MMR, what is the constituent that protects against mumps? Measles?
all three are live attenuated vaccines
Four presentations of Mumps
parotitis, orchitis, meningitis, encephalitis
Four complications of measles.
pneumonia, eye damage, myocarditis, encephalitis
Measles is also called
Other than RSV, what other groups of viruses can cause syncytial cells?
herpesviridae and retroviridae
Is bilirubin more likely to be elevated early in acute hepatitis or in biliary obstruction?
biliary obstruction
Liver enzymes are higher in (acute or chronic) hepatitis?
Hepatitis A is milder in kids or adults?
How are Hep A and E transmitted?
fecal-oral (anal, enteric)
what kind of vaccine is the Hep A vaccine?
What kind of vaccine is the Hep B vaccine?
recombinant HBsAg
Which of the hepatitis viruses is a DNA virus?
Hep B
The Hep B particle is called
dane particle
Two complications of HBV.
primary hepatocellular carcinoma, and cirrhosis
The serological profile of an immunized person (Hep B) will show positive -----
HBsAb only
Can only replicated with the help of HepB because it needs the HBsAg for itself.
Hep D
Hep D can manifest itself in what two ways?
co-infection, and super-infection (acute on chronic hepatitis)
HepE rarely occurs here in the US. Where is it common? What family of virus is HepE part of?
1.Asia, india, central america, and africa
What group of people are most seriously affected by Hep E
pregnant women (high mortality)
What percentage of those infected with Hep C go on to develop chronic disease?
What are the three essential retroviral enzymes?
protease, reverse transcriptase, and integrase
major capsid protein of HIV, can be measured in serum to detect early HIV infection
What gene encodes p24?
What is encoded by pol
protease, reverse transcriptase, and integrase
The env gene products bind to what receptors?
CD4 receptors
Name two other cell types that can become infected with HIV
macrophages, monocytes, CNS dendritic cells
What is the mechanism of autoantibody production in HIV?
HIV infection results in polyclonal activation of B cells, resulting in the outpouring of immunoglobulins --> immune complex formation and autoimmunity
How is HIV carried to the brain, if T cells don't cross the BBB?
monocytes and macrophages cross the BBB and are reservoirs for HIV
What malignancy has a high incidence in HIV? What malignancy is more common in homosexuals?
B-cell lymphoma. Kaposi's sarcoma (HHV-8)
Most common opportunistic infection
parasite causing mass lesions in the brain
toxoplasma gondii
within weeks of infection, what test can be done for HIV?
test for p24 protein
After 3-6 weeks of exposure, what test can be done?
ELISA for HIV antibodies
If ELISA is positive twice, what test can be done to confirm diagnosis?
western blot
Members of this family of viruses in the alpha subgroup (HSV1, HSV2, VZV) have a cytopathic effect on cells, producing multinucleated giant cells with intra----- inclusion bodies.
What type of immune response fights herpesviridae?
cell-mediated immune response
During latency, herpesviridae live in ---- ganglia.
Intranuclear inclusions represent areas of ------ ------.
viral assembly.
Viral proteins are inserted into the host cell plasma membrane, causing ------ ------ ----- to form.
multinucleated giant cells to form.
Most common infectious cause of corneal blindness in US.
HSV1 herpetic keratitis
Most common cause of viral encephalitis in US. Patients present with FEVER and FOCAL NEUROLOGICAL ABNORMALITIES.
Is herpes encephalitis treatable?
Two of the TORCHES organisms that can cross the blood-placenta barrier that are also herpesviridae.
CMV, HSV (mainly 2)
cause of chickenpox.
varicella-zoster virus
The rash of varicella starts on the ----- and ------, then spreads to the entire body.
face, trunk
The skin vesicles in varicella are described as -------.
dew on a rose petal.
T/F. Skin lesions of varicella are all in the same stage at one time.
False. The lesions can be at various stages.
Dermatomal distribution of vesicles. Exquisitely painful. V1 involvement (see if the nose is involved) can lead to blindness.
Zoster (shingles)
Most common viral cause of mental retardation.
CMV causes two different patterns of infection in two different immunocompromised populations. For each of the following patterns, name the population.
CMV retinitis, viremia, colitis
AIDS = retinitis
CMV pneumonitis, viremia, colitis
Marrow transplant = pneumonitis
CMV pneumonitis
Marrow transplant = pneumonitis
Which layer of centrifuged blood is most likely to yield CMV for culture, and why?
CMV invades WBCs, so the buffy coat should be cultured.
Major cause of mononucleosis.
EBV infects ----- cells.
EBV-associated cancer found in central Africa
Burkitt's lymphoma. Read p. 207
High white blood cell count with ATYPICAL LYMPHOCYTES on blood smear. HETEROPHILE antibody positive. What disease is this? What are these atypical lymphocytes and what is the heterophile Ab?
Mononucleosis. Atypical lymphocytes = large activated Tcells. Heterophile Ab = Ab to EBV that cross reacts with sheep rbcs (Monospot test)
Kaposi's sarcoma associated virus
Periventricular calcifications in a neonate; mother with flu-like illness: what TORCHES condition is this?
congenital CMV
Cataracts, thrombocytopenia, purpura, PDA, bone lucency, meningoencephalitis in baby; mother with maculopapular rash some time during pregnancy
congenital rubella (rubivirus, a togavirus)
Baby with bone and teeth abnormalities and condyloma lata, saddle nose deformity
congenital syphilis
Murky brown amniotic fluid secondary to amnionitis (bacterial, not a TORCHES organism; causes meningitis in neonates.)
neonatal listeriosis
Structurally most complex of all known viruses
Pox, unlike other DNA viruses, carries many of the enzymes it needs and replicates in the -----
Umbilicated papules caused by a pox virus. Often seen in AIDS pts
molluscum contagiosum
Papova viruses include papilloma and polyoma virus groups. What two viruses make up the polyoma group
JC and BK
Cervical carcinoma is associated with HPV types
16 and 18
Low risk HPV types
6, 11
JC virus is the agent of ----- ------ -----
progressive multifocal leukoencephalopathy
What do adenoviruses do?
cause upper respiratory infection in kids
List the top four viral respiratory illnesses in children in order.
(1) RSV (2) Parainfluenza virus (croup) (3) Rhinovirus (4) Adenoviridae
Only DNA virus with single strand of DNA.
Parvovirus causes what condition in children that presents with fever and a slapped cheeks rash?
erythema infectiosum (Fifth disease)
arthropod borne viruses are called what?
What are the three groups of arboviruses?
Flaviviridae, bunyaviridae, and togaviridae
A large family of enteroviruses that includes Hep A, poliovirus, coxsackie A&B, and echoviruses.
Name two viruses that cause the common cold
Rhinovirus and coronavirus
Name two viruses that cause diarrhea
Rotavirus (a reovirus has DS RNA, unlike other RNA viruses) and calicivirus (includes Norwalk)
Name the two manifestations of arbovirus infections
fever and encephalitis
The equine encephalitides are caused by what sub group of the arboviruses?
The agent that causes German measles is not a paramyxovirus like the measles virus. What is it?
Rubivirus ( a toga virus that is not an arbovirus) the disease is mild with fever and rash that spreads like the measles rash from head to toe
What are the TORCHES organisms?
Toxo, Rubella, CMV, Herpes/HIV, Syphilis
Congenital rubella causes problems in what three main organs?
heart, eye, CNS
What is the rubella vaccine?
live attenuated (all three in MMR are live attenuated)
Dengue causes death via what physiological effects?
hemorrhage and shock
Cause of of Rift Valley Fever is a ---virus
Bunnies hopping around in the Rift Valley
This viral illness should be considered in a young person from Arizona with flu-like symptoms and pulmonary edema
Hanta virus
Bunnies in Arizona
What neurons does the poliovirus destroy in a case of paralytic poliomyelitis?
destroys presyaptic motor neurons in the anterior horn of the spinal cord as well as the postsynaptic neurons leaving the horn
Causes painful contraction of pharyngeal muscles on swallowing and results in hydrophobia
What kind of paralysis results in poliomyelitis?
The salk vaccine is what kind of vaccine?
What kind of vaccine is the oral polio (Sabin vaccine)?
live attenuated
The most common cause of aseptic meningitis in the US
enteroviruses (Coxsackie A and B, Echoviruses, etc.)
What is the condition? Fever, vomitting, abdominal pain, diarrhea after a 1-2 day incubation. Symptoms resolve in 4-7 days.
Viral gastroenteritis
Viral gastroenteritis is caused by which two viruses?
Rotavirus(Reo) and calicivirus (includes Norwalk)
Rotavirus belongs to a family called -----, which is the only family of RNA viruses that is double stranded.
Collections of virions in the cytoplasm called Negri bodies in neurons are pathognomonic for ----
Death in rabies occurs secondary to ----- ----- -----
respiratory center dysfunction
Guanine analogs that act against the herpes family
acyclovir, gancyclovir
Why is it that acyclovir does not have a deleterious effect on human cells?
it must first be phophorylated. Viruses have this thymidine kinase, we do not
However there is some toxicity to rapidly dividing cells, so ----- and ----- are side effects.
neutropenia, thrombocytopenia
Which herpes virus lacks the thymidine kinase, making it less susceptible to acyclovir. Gancyclovir must be used instead because it is not dependent on the kinase.
IF given in high doses, acyclovir may crystallize in the -----
Has broader coverage of herpes viridae but is more toxic
Because of its toxicity, gancyclovir is used only for ---- in immunocompromised hosts.
Foscarnet mechanism of action
pyrophosphate analog inhibits DNA polymerase and reverse transcriptase
Foscarnet covers both HIV and ----
With Foscarnet, increased ----- potential is possible in patients with a Hx of this, head trauma, renal impairment.
First line standard of care for Hiv
two nucleoside RT inhibitors + one protease inhibitor OR two nucleoside RT inhibitors+ one non-nucleoside RT inhibitor
Drug that has reduced MTCT from 30% to 8%
In addition to HIV therapy, lamivudine also plays a role in the Tx of ----- ------ as monotherapy or with interferon alpha
hepatitis B
Nucleoside analogs need phosphorylation to become active, but non-nucleotide RT inhibitors do not. Name three NNRTis
Nevirapine, delaviridine, efavirenz
Frequently reported side effect of NNRTis
all the drugs that end in -navir are ---- ---
protease inhibitors
Amantidine only inhibits uncoating of which virus?
influenza A
Oseltamivir and Zanamavir work by inhibiting -----, a virulence factor of Orthomyxoviruses (influenza type A and B)
Ribavirin has a wide spectrum of activity against both DNA and RNA viruses. However, there are concerns about safety (severe teratogen, hemolytic anemia), so it is used only for severe ---- infections in infants and for ---- --- in Africa
RSV; Lassa fever
How does Ribavirin work?
it inhibits synthesis of guanine nucleosides by competitivevly inhibiting IMP dehydrogenase.
What is interferon used to treat?
Chronic hepatitis B and C, Kaposi's sarcoma
What is the main side effect of interferon?
How to remember the positive RNA viruses?
Positively, Pico was having a Flaviful Corona at the retro Toga party in California.

There are only three RNA viruses with no envelope- how do you remember them?
PICO and I went to California with my convertible Reo!

Picovirus, Calicivirus, Reovirus
Which Vaccines are live strains(meaning they have been attenuated)?
1. MMR (Measles, Mumps, Rubella)
2. Adenovirus
3. Polio (Sabin)- (Salk is killed)
4. VZV (Varicella)
5. Yellow fever virus (Flavi family)

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