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Virology 2 > Questions from S 9 > Flashcards

Questions from S 9 Flashcards

1
Q

Actual exam question autumn 2023

Poultry owner with respiratory symptoms

Likely diagnosis, treatment, infection control

A

Answer not known

Avian Influenza A (H5N1 most common)

Oseltamivir 75mg BD

Discharge if possible/ well
Neg pressure side room
FFP3/ visor/ gloves/ gown

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2
Q

Actual exam question autumn 2023

Patient has liver transplant, and 1 week after develops acute liver failure

What is the likely diagnosis?

A

HSV is the answer

Donor CMV+, recipient CMV-
CMV disease would normally present at 3 months following infection, rather than acute
Patient should already be on prophylaxis for CMV following transplant

Differential:
HSV
VZV
Adeno
EBV
CMV
HAV
HBV
HCV
HEV

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3
Q

Actual exam question autumn 2023

Patient has liver transplant, and 1 week after develops acute liver failure

Which of these infections occur early after liver transplant?

<1 month after transplant

1-6 months after transplant

HSV
VZV
CMV
EBV
HHV6
HHV7

A

hepatitis <1 month from transplant
HSV
VZV

hepatitis 1-6 months from transplant
CMV
EBV
HHV6
HHV7

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4
Q

Actual exam question autumn 2023

13 year old presents with rash

What further information do you want?

A

Type of rash - macular/ papular/ vesicular

Is rash uniform - VZV is not uniform, as you have macular lesion, vesicles, crusted lesions. MPox has uniform lesions

Chickenpox history. If parents confirm previous chickenpox, that is enough confirmation

MMR history

Unwell contacts

Travel - any travel to Africa for Mpox

Sexual history - not important at this age

Prodromal symptoms - fever, fatigue, myalgia, conjunctivitis, SOB, neurological features. Can help push towards Mpox/ VZV/ Measles

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5
Q

Mpox

Which clade is the more severe one?

A

Clade I has higher mortality. Central African clade e.g DR Congo. Managed as a HCID

Clade II. West African clade e.g Nigeria
Clade II.b caused global outbreak

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6
Q

Actual exam question autumn 2023

13 year old presents with rash following travel to Nigeria

Rash is vesicular

What is the differential diagnosis?

A

VZV - although in the case parents confirm previous chickenpox

HSV - disseminated HSV is rare if not immunocompromised

Enterovirus

Mpox - history of travle ot Nigeria. Which makes clade 2 more likely

Molluscum contagiosum

Orthopox- Mpox, Cowpox

Parapox - Orf

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7
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria

What investigations would you perform?

A

Swab lesions for viral PCR
- HSV/ VZV/ Entero/ Mpox

Throat swab for viral PCR
- MPox

Urine sample for viral PCR
- MPox

If unwell, EDTA for Mpox blood PCR

HIV test

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8
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria

What is the incubation period for Mpox

A

1-21 days incubation

usually 7-14 days

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9
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria

What is your initial management?

A

If HSV/ VZV - aciclovir

HIV test

Side room - with contact/ respiratory precautions.
Likely Clade IIb, so not a HCID. Does not require negative pressure side room

contact trace - off PEP to contacts

treat any secondary bacterial infections

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10
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria

What is treatment of Mpox?

A

Tecovirimat 600mg BD 14 days

Cidofovir 5mg/kg once week

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11
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria. Found to be Mpox

How do you risk stratify contacts?

A

High risk category 3-
direct exposure with broken skin to Mpox or body fluids without PPE

Medium risk category 2
intact skin-only contact with an Mpox or body fluids without PPE

Low risk category 1
Contact with Mpox whilst wearing PPE, or contact but not closer than 1metre to case

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12
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria. Found to be Mpox

What is mechanism of action of tecovirimat?

A

p37 inhibitor

Tecovirimat inhibits the function of a major envelope protein required for the production of extracellular virus. The drug prevents the virus from leaving an infected cell, hindering the spread of the virus within the body

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13
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria. Found to be Mpox

Contacts identified, and you plan to give vaccine.

When is vaccine given?

A

2x doses
day 0 and day 28

1x dose if previous history of smallpox vaccine

give within 4 days of exposure
up to 14 days after exposure

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14
Q

Actual exam question autumn 2023

13 year old presents with vesicular rash following travel to Nigeria. Found to be Mpox

How do you manage these risk groups?
Who requires vaccine PEP?

High risk - category 3
Medium risk - category 2
Low risk - category 1

A

High risk - category 3
consider exclusion from work for 21 days from contact
isolate at home
vaccine PEP

Medium risk - category 2
passive monitoring
advise avoid close sexual contact for 21 days
vaccine PEP

Low risk - category 1
none

Basically - anyone with a contact with Mpox patient, who is not wearing full PPE

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15
Q

What is the Mpox vaccine based on?

A

it is a smallpox vaccine based on Vaccinia virus

modified vaccinia Ankara (MVA-BN) (Imvanex/ Jynneos) vaccine

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16
Q

When does Mpox vaccine need to be given for contacts?

A

Within 4 days of exposure

But up to day 14 after exposure

17
Q

How is Mpox vaccine given?

A

IM or SC

18
Q

Mpox vaccine also used in staff who have occupational exposure to virus in the lab

What is vaccine schedule for these people?

A

2x doses at day 0 and day 28

Booster dose at 2 years

19
Q

Actual exam question

How many strains of Parainfluenza are there in UK?

Which is the most common strain in the UK?

A

4 strains

Parainfluenza-3 is most common

Most virulent - causes most severe disease including bronchiolitis/ pneumonia

20
Q

Actual exam question

What are most common causes of flu in the UK?

A

Always write out full name

Influenza A H1N1(pdm2009)
Influenza A H3N2
Influenza B (Yamagata/ Victoria)

Virology 2 (57 decks)

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