CH32: Viral Infections, Prion Diseases

Question 1

Virus traveling via retrograde axoplasmic transport (p. 763)

Answer 1

HSV, VZV, rabies

Question 2

Certain viruses depend on cell-surface receptors in ingress into the cell. Which virus uses serotonin receptor? (p. 763)

Answer 2

JC Virus (to go into the oligodentrocytes)

Question 3

Most frequent symptom of acute aseptic meningitis (p. 763)

Answer 3

Headache

Question 4

Mild depression of the CSF glucose occurs with meningitis caused by (p. 764)

Answer 4

mumps, HSV2, lymphocytic choriomeningitis, VZV

Question 5

Most common viral causes of acute aseptic meningitis (p. 764)

Answer 5

echovirus, Coxsackie virus

Question 6

Underlies many cases of what has been traditionally considered as idiopathic Bell’s palsy (p. 765)

Answer 6

HSV-1

Question 7

Patients infected by these virus have exanthemata that may be associated with grayish vesicular lesions of oral herpangina (p. 765)

Answer 7

Echovirus, Coxsackie virus

Question 8

Irritability, febrile, seizures but brachial neuritis in adults. Strokes have also been identified but rare (p. 765)

Answer 8

Parvovirus

Question 9

Main organisms causing encephalitis in the immunocompromised (p. 765)

Answer 9

HHV6, CMV, VZV

Question 10

Also associated with HSV2, aseptic meningitis, bladder failure and vaginal or vulvar pain after a bout of genital herpes (p. 767)

Answer 10

Elsberg syndrome

Question 11

Most common sporadic cause of encephalitis and has no seasonal or geographic predilection (p. 769)

Answer 11

HSV

Question 12

Incubation period after mosquito or tick bite transmission duration (p. 770)

Answer 12

5 to 15 days

Question 13

Pathologic finding in Arboviral encephalitis (p. 771)

Answer 13

Perivascular cuffing by lymphocytes and other mononuclear leukocytes and plasma cells, as well as patchy infiltration of the meninges with similar cells

Question 14

HSV 1 or 2: encephalitis (p. 771)

Answer 14

HSV 1

Question 15

HSV 1 or 2: aseptic meningitis, polyradiculitis or myelitis (p. 771)

Answer 15

HSV 2

Question 16

HSV Pathology (p. 771)

Answer 16

intense hemorrhagic necrosis of the inferior and medial temporal lobes and mediorbital parts of the frontal lobes

Question 17

2 route of entry of HSV into the CNS (p. 771)

Answer 17

1. trigeminal ganglia

2. fibers innervating hte leptomeninges of the anerior and middle fossa

Question 18

EEG finding in HSV encephalitis (p. 772)

Answer 18

lateralized periodic high- voltage sharp waves in the temporal regions and slow- wave complexes at regular to 2-3s intervals

Question 19

Treatment for HSV (p. 772)

Answer 19

Acyclovir 30mg/kg/day for 14 to 21 days

Question 20

Virus associated with encephalitis in patients undergoing stem cell transplant (p. 773)

Answer 20

HHV 6

Question 21

Pathologic finding of Rabies (p. 774)

Answer 21

Cytoplasmic eosinophilic inclusions called Negri bodies

Question 22

Focal collections of microglia in Rabies patients (p. 774)

Answer 22

Babes nodules

Question 23

Shown to inactivate the rabies virus. Clean the wounds with this one (p. 774)

Answer 23

Benzyl ammonium chloride

Question 24

How to give HRIG (p. 774)

Answer 24

20U/kg of body weight; half around the wound, half IM

Question 25

Cerebellitis most often associated with? (p. 774)

Answer 25

Chicken pox

Question 26

Herpes Zoster multiplication in epidermal cells causing swelling, vacuolization, lysis of cell boundaries leading to the formation of these vesicles (p. 775)

Answer 26

Lipschutz inclusion bodies

Question 27

Most common site (dermatome) of varicella zoster (p. 776)

Answer 27

T5- T10

Question 28

Facial palsy in combination with a herpetic eruption of the external auditory meatus (p. 776)

Answer 28

Ramsay Hunt Syndrome

Question 29

Acute hemiparesis, hemianesthesia, aphasia, elevated IgG in the CSF in Herpes Zoster (p. 777)

Answer 29

Zoster angitis

Question 30

When to give treatment for Herpes Zoster? (p. 777)

Answer 30

Acyclovir should begin within approximately 48hours of the appearance of the rash.

Question 31

Other treatment for Herpes Zoster (p. 777)

Answer 31

Famciclovir and valacyclovir

Question 32

Severely painful syndrome following chicken pox occurs in how many percent? (p. 778)

Answer 32

5-10 percent

Question 33

HIV dementia pathology (p. 780)

Answer 33

diffuse and multifocal rarefaction of the cerebral white matter accompanied by scanty perivascular infiltration of lymphocytes and clusters of few foamy macrophages, microglial nodules, and multinucleated giant cells

Question 34

HIV dementia described as widespread astrocytosis and microglial activation in the cerebral cortex with little recognizable neuronal loss (p. 780)

Answer 34

diffuse poliodystrophy

Question 35

description of HIV neuropathy (p. 780)

Answer 35

distal, symmetrical, axonal polyneuropathy, predominantly sensory and dysesthetic in type

Question 36

Treatment of HIV causing myopathy (p. 781)

Answer 36

Zidovidine

Question 37

Of focal infectious complications, this is the most frequent focal infectious complications (p. 781)

Answer 37

Cerebral toxoplasmosis

Question 38

Alternative treatment for Toxoplasmosis (p. 781)

Answer 38

Clindamycin

Question 39

Progressive multifocal leukoencephalopathy found wheen CD4+ counts are below (p. 781)

Answer 39

< 50 cell per microliter

Question 40

Among the nonfocal neurologic complications of AIDS, the most common are (p. 781)

Answer 40

CMV and cryptococcal

Question 41

Treatment of CMV (p. 782)

Answer 41

Ganciclovir, Foscarnet

Question 42

Slowly progressive spastic gait with early sphincter control difficulty and some degree of later proprioceptive loss of Romberg sign (p. 783)

Answer 42

HTLV1 Myelopathy

Question 43

Agent used in the treatment of T-cell lymphoma which has been found to have activity against the virus and may have been effective in this disease (p. 783)

Answer 43

HTLV 1

Question 44

Reservoir of poliomyelitis (p. 783)

Answer 44

Human intestinal tract

Question 45

Bulbar symptoms of poliovirus because this structure is most frequently involved (p. 784)

Answer 45

Nucleus ambiguus

Question 46

Earliest histopathologic changes in the anterior horn (p. 784)

Answer 46

Central chromatolysis of the nerve cells along with an inflammatory reaction

Question 47

Progressive Multifocal Leukoencephalopathy occurs in which patients (p. 786)

Answer 47

lymphoma, CML, immunodeficient states

Question 48

Characteristic feature in pathology of PML (p. 787)

Answer 48

enlargement of oligodendrocytes, some bizarrely shaped with intranuclear inclusions

Question 49

EEG of SSPE (p. 788)

Answer 49

periodic (every 5 to 8s) bursts of 2 to 3/s high voltage waves followed by a relatively flat pattern

Question 50

Histopathologic feature of SSPE (p. 788)

Answer 50

Eosinophilic inclusions found in the cytoplasm and nuclei of neurons and glia cells

Question 51

Most extraordinary feature of this diease is appearance of a parkinsonian syndrome after an internal of weeks or months (p. 789)

Answer 51

Encephalitis lethargica (von Ecomo disease)

Question 52

Most common type of CJD (p. 791)

Answer 52

MM1 and MV1

Question 53

CJD wherein cerebellar ataxia precede the mental changes (p. 791)

Answer 53

Brownell- Oppenheimer variant

Question 54

CJD wherein visual disturbances precede the mental changes (p. 791)

Answer 54

Heidenhain variant

Question 55

EEG finding in CJD (p. 791)

Answer 55

diffuse and nonspecific slowing to stereotyped high voltage slow (1-2Hz) and sharp-wave complexes on an increasingly slow and low-voltage background

Question 56

MRI of CJD (p. 791)

Answer 56

hyperintensity of the lenticular nuclei on T2 weighted and diffusion weighted images in the BG and cortex

Question 57

Difference of SSPE and CJD (p. 793)

Answer 57

SSPE: children, young adults, elevated CSF IgG CJD: middle age presenile, CSF normal

Question 58

prion disease wherein: progressive cerebellar ataxia, corticospinal tract signs, dysarthria and nystagmus; less dementia (p. 793)

Answer 58

Gerstmann-Straussler-Scheinker Syndrome

Question 59

Localization of fatal insomnia (p. 793)

Answer 59

Medial thalamic nuclei

Question 60

Gene affected in fatal insomnia (p. 793)

Answer 60

prion gene at codon 178, methionine at codon 129 on chromosome 20

Question 61

laughing sickness (p. 793)

Answer 61

Kuru