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Clinical Medicine II > Viral Infections Part II > Flashcards

Viral Infections Part II Flashcards

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1
Q

Where does the rabies virus infect?

A
  • Central Nervous system
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2
Q

What is the #1 cause of rabies in the US

A
  • Bat bites
#2 Raccoons 
#3 Skunks 
#4 Foxes
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3
Q

What are S&S that depict rabies?

A
  • Acute
  • Progressive to encephalomyelitis
  • Can’t be stopped
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4
Q

What is the incubation period of rabies?

A
  • Normally 10 to 90 days

- Rarely 7 years

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5
Q

T of F

Rabies symptoms are progressive?

A
  • True

Initially

  • Fever
  • Headache

Progresses to

  • Anxiety
  • Confusion
  • Agitation
  • Hypersalivation
  • Difficulty/Painful
    swallowing
  • Hydrophobia

Eventually

  • Death
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6
Q

How do you Dx Rabies?

A
  • CSF PCR
    Maybe negative early in disease
  • Skin Bx
  • MRI
    Maybe Grey matter involvement
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7
Q

Tx for Rabies?

A
  • Local wound cleansing & Debridement
  • Local and Distal Anti rabies Immunoglobulin
  • Systemic Vaccination
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8
Q

Who must receive Pre Exposure prophylaxis rabies vaccine?

A
  • Traveling to Africa

- Zoo Employees

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9
Q

T of F

CMV (Herpes) is a common infection in the US?

A
  • True

- Very common

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10
Q

Most pts with CMV infections are ?

A
  • Sub Clinical Asymptomatic

- Disease is Self limiting in a normal host

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11
Q

Who is at higher risk of CMV infections?

A
  • Elderly pt’s
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12
Q

When is CMV usually presenting with symptoms?

A
  • Immunocompromised Pt’s
  • Usually presents like Mononucleosis (EBV)
  • Severe CMV
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13
Q

How is CMV transmitted?

A

Acquired CMV

  • Sexual contact
  • Breast milk
  • Blood transfusion
  • Respiratory droplets
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14
Q

What are the the common S&S of CMV?

A
  • Resembles Mononucleosis (EBV)

- Without Pharyngitis or Respiratory symptoms

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15
Q

What are some EBV and CMV common S&S?

A
  • Fever
  • Malaise
  • Myalgias / Arthralgias
  • Enlarged Spleen
  • Abnormal spleen
  • Abnormal LFT
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16
Q

T of F

Perinatal CMV is common with infection mothers during pregnancy?

A
  • True 10%

- Infant maybe symptomatic at first

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17
Q

Clinical findings in an infant with CMV?

A
  • Jaundice
  • Hepatospleenomegly
  • Thrombocytopenia
  • Mitral Regurgitation
  • Motor disability
  • Purpura
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18
Q

Retinitis in an Immuno Compromised Pt’s with CMV will show?

A
  • “Pizza Pie” Neovascularization and Proliferative Macula lesions
  • (CD4 < 50)
  • Treat HIV control CMV
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19
Q

Immuno Compromised Pt’s with CMV will be at risk of?

A
  • Retinitis
  • GI symptoms
  • Pulmonary symptoms
  • Neurological symptoms
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20
Q

Dx of CMV includes?

A
  • PCR (CSF, Blood or Urine)
  • Will show CMV Antigens
  • Tissue Bx
  • Will show intracytoplasmic inclusions (Owl Eyes)
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21
Q

Tx of CMV in a healthy pt is required?

T of F

A
  • False

- Only Tx if Pt is in severe organ system disease

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22
Q

How do you prevent CMV?

A
  • Limit blood transfusion (filtering to remove leukocytes)

- Restricting the organ donor pools to seronegative donors

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23
Q

Tx of pts with severe organ diseases with CMV includes?

A

Preferred Tx

  • Valacycylovir (PO)
  • Ganciclovir (IV)
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24
Q

HPV only infects humans with 200+ types of strains, what are the two sub-types?

A
  • Cutaneous

- Anogenital

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25
What are the two HPV types associated with cancer?
- HPV 16 and 18
26
What are the most common two types of HPV associated with Cutaneous genital warts (Condyloma acuminatum)
- HPV 6 & 11 | - 90% of Genital warts (20 & 24y/o)
27
What are the HPV strains that causes regular skin warts?
- HPV 1, 2, 3, 4, 10 | - Common in kids
28
T or F HPV can cause Anal and Oropharyngeal cancer?
- True - Anal (W>M) - Oral (Tongue and Oralpharynx)
29
T or F HPV can causes Cervial, Vulvar and Vaginal cancer?
- True - Cervical common 4th leading cause - Vulvar and Vaginal uncommon
30
How do you detect HPV?
- Cervical and Oral Bx
31
How many vaccines are there for HPV?
- 3 vaccines | - All 3 with Direct benefit for M and W against cancer
32
HPV 9 Valent vaccine (Gardasil 9) protects against?
- HPV types 6,11,16,18,31,33,45,52,58
33
HPV Quadravalent vaccine (Gardasil) protects against ?
- HPV types 6,11,16 & 18
34
HPV Bivalent vaccine (Cervarix) protects against ?
- HPV types 16 & 18
35
What is the age range and doses for the HPV vaccines?
- 3 Doses M and F - As early as 9 y/o - As late as 26 y/o
36
What is a major concern wit HPV and pregnancy?
- Juvenile laryngeal papillomatosis - Debilitating disease in children - Maternal - Fetus transmission unknown
37
Tx of HPV in a pregnant mother?
Small genital disease: - Tirchloroacetic acid Large genital disease: - Carbon dioxide laser
38
What is the deadliest month of the Flu in american history?
- October 1918 | - 195k deaths
39
Who is at higher risk with influenza?
- Kids < 5 - Elderly > 65 - Pregnancy (3rd Trimester) - Chronic diseases
40
What can be a complication of the flu?
- Viral lung issues (Infiltrate everywhere) - Weakens lungs - Causes Bacterial Pneumonia (Infiltrate concentrated)
41
The flu A or B is ?
- Acutely debilitating - Self limiting - Winter months
42
Incubation period of the Flu?
- 1 to 4 days | - 2 days average
43
What happens after the incubation period of the flu?
- Abrupt onset - Fever (100 - 106) - Headache - Malgias - Arthralgias - Weakness
44
What respiratory symptoms are associated with the flu?
- Non productive cough - Sore throat - Nasal discharge
45
T of F GI symptoms with the Flu are common in kids?
- True
46
When can pt's start feeling better from the Flu?
- Improvement in 2 to 5 days
47
What are PE findings associated with the Flu?
- Diminished breath sounds +/- wheezing - Flushed face - Conjunctival redness (Red Eyes)
48
When can Flu viral shedding occur?
- 24 to 48 hours before the onset of symptoms
49
When is the rapid flu test used and on who?
- Adults with area known to have influenza (Nasopharynx) | - Detects A and B flu strains
50
When does the rapid influenza test provide the highest sensitivity?
- Early viral shedding stages (24 to 48 hours before symptoms) - 50 to 70% sensitivity - 10 results
51
T of F Labs are helpful for Flu dx?
- False
52
What is the gold standard for influenza Dx?
- Viral PCR - 98% Sensitivity - 1-2 day turn around
53
Can the Rapid Influenza Test provide false negatives with a flu swab? T of F
- True | - Institution specific
54
What is the antiviral DOC for the flu A & B?
- Oseltamivir (Tamiflu) (pill & liquid) - Nausea and Vomiting
55
What are other options for antiviral's for the flu A & B?
- Zanamivir (Relenza inhaler) - Severe bronchospasm in pts with underlying ling Dz - Peramivir (Rapivab IV) - Nausea & Diarrhea
56
What antivirals should not be used in the US (Resistance to A influenza issues) ?
- Amantadine | - Rimantadine
57
When must antivirals be started by to be effective?
- 24 to 48 hours | - Shortens course of illness by 1/2 to 3 days
58
What are prevention strategies for the Flu?
- Flu vaccine - Hand washing - Respiratory hygiene - Avoid crowded areas during peak flu season (Winter)
59
If you get a negative with a rapid test but still suspect the flu should you consider antivirals?
- Yes - Consider Tx because the test could be wrong - False negative
60
What is the minimum age recommendation for the flu vaccine if no contraindications?
- 6 + months
61
T of F The Zika virus my cause no symptoms or only mild symptoms?
- True
62
T or F There is no local transmission of Zika in the US?
- True
63
What are the major concerns with the Zika virus?
1) Congenital effects (10% High risk) Birth defects | 2) Perinatal effects
64
What are the congenital effects of the Zika virus?
- Micorcephaly - Decreased brain tissue - Contractures - Macular scarring - Seizures
65
What are the major Perinatal effects with the Zika Virus?
- Maculopapular rash - Conjunctivitis - Arthralgia - Fever
66
Where is the highest incidence rate of HIV (Epidemic) 30+ Million world wide?
#1 Africa #2 South East Asia #3 Americas
67
How is HIV transmitted?
- Bodily fluids
68
T of F Needle sticks in the hospital have a high rate of HIV transmission?
- False
69
How does an HIV pt present at first?
- Mononucleosis like syndrome - Constellation of non specific symptoms - Can be missed if not suspected
70
How long from the time of exposure do HIV pt's usually develop symptoms?
- 2 to 4 weeks from inoculation | - 10% to 60% are asymptomatic
71
What are the most common S&S of an acute HIV pt?
- Fever, Fatigue, Myalgias (MOST COMMON) - Lymphadenopathy (Axillary, Cervical, Occipital) - Sore Throat
72
HIV acute pts usually have a sore throat with? Hallmark Sign
- Painful mucocutaneous ulcerations (Oral Ulcers) | - Most distinctive manifestations of HIV disease
73
Other less common S&S of HIV?
- Fever then Rash (Trunk Rash) last for 5 to 8 days - Diarrhea - Weight Loss - Headache (Retrobulbar worsened by eye movement)
74
What would raise your suspicion for acute HIV infection?
- Prolonged course (Weeks) | - Oral ulcers
75
What is the screening method used for HIV?
- Enzyme Linked Immunosorbent assay (ELISA) - 50% positive within 22 days - 95% positive within 6 weeks #1 ELISA Confirm repeat study #2 ELISA + #3 Western Blot
76
What is the HIV rapid antibody test?
- Easy, Quick Test (10Mins) | - If positive MUST confirm with ELISA & Western blot
77
The western blot confirmation test is reliable early in the infection ? T or F
- False | - Not reliable
78
What must you monitor during an HIV infection?
- CD4 count - Indicated pt's prognosis - Susceptibility to opportunistic infections
79
What increases the risk HIV to AIDS opportunistic infections or Malignancy?
- CD4 < 200
80
What test monitors the HIV progression and response to antiretroviral medications?
- Viral Load test | - May ping positive in acute HIV infection (Before Seroconversion)
81
T or F You must consider referral to an ID specialist for antiretroviral therapy?
- True | - In acute HIV pt's
82
What increases the risk of opportunistic infections in an HIV pt?
1) Environment (TB endemic, Mycobacterium, SCC, Merkel Cells, Lymphomas) 2) Behavioral Factors (Drug use) 3) Demographics
83
What does the HIV infection rely on for opportunist infections?
1) Environment | 2) Behavioral
84
What are some opportunist infections associated with HIV?
- PCP - Toxoplasma encephalitis - CMV retinitis - Cryptococcal meningitis - Cryptosporidiosis - Microsporidiosis - Kaposi sarcoma - Squamous Cell carcinoma - Merkel Cell - Lymphomas
85
What are the opportunistic infections associated with HIV and CD4 counts > 200
1) Bacterial infections 2) TB 3) Herpes Simplex 4) Herpes Zoster 5) Vaginal Candidasis 6) Hairy Leukoplakia (EBV) 7) Karposi Sarcoma
86
What are the opportunistic infections associated with HIV and CD4 counts < 200
1) Pneumocystosis 2) Toxoplasmosis 3) Cryptococcosis 4) Cryptosporidiosis 5) Coccidioidomycosis
87
What are the opportunistic infections associated with HIV and CD4 counts < 50
1) Disseminated MAC infection 2) Histoplasmosis 3) CNS Lymphoma 4) CMV Retinitis
88
What does HIV care maintenance require?
Baseline - Genetic resistance testing - LFT - HA1C 3 - 6 months test - CD4 Counts - Viral loads - CBC, CMP, LFT - HA1C
89
What vaccines must be up to date on HIV pt's?
1) Pneumococcal 2) Meningococcal 3) Herpes zoster 4) Flu 5) Hep A and B 6) Tdap 7) HPV for females
90
What prophylaxis's treatment is done on HIV pts with < 200?
- Pneumocystis jirovecii prophylaxis (trimethoprim-sulfmethoxazole)
91
What prophylaxis's treatment is done on HIV pts with < 75 ?
- Mycobacterium avium prophylaxis (azithryomycin)
92
What prophylaxis's treatment is done on HIV pts with < 50 ?
- CMV prophylaxis
93
T or F Pts being treated for HIV can develop metabolic syndrome due to medications?
- True
94
True - False ID specialist are the specialist in charge of the multi drug regime for HIV pt's
- True | - Usually fixed doses (Vir Drugs) which simplify's it
95
Pre-Exposure prophylaxis treatments for HIV are offered to all pts? T of F
- False | - Only offered to high risk Pt's
96
What are the two Pre-Exposure prophylaxis HIV medications?
1) Tenofovir 2) Emtricitabine (Truvada) - Might be covered by Ins - $1700 a month
97
What are the Post exposure policies for HIV prophylaxis ?
- Exposure type and - HIV status of pt
98
What is the goal for Post Exposure HIV prophylaxis treatment?
- Within 1 to 2 hours of exposure | - Not effective after 72 hours
99
The type of exposure of HIV correlates to the risk of sero conversion, what increases the risk?
- Deep injury - Device visibly contaminated with blood - Source patient with high viral load
100
What are the 3 medications used for Post Exposure HIV prophylaxis treatment?
- Tenofovir + Emtricitabine + Raltegravir
101
What bodily fluids MIGHT transfer HIV?
1) CSF 2) Synovial Fluid 3) Peritoneal 4) Amniotic
102
What bodily fluids INCREASES the risk of HIV transmission?
1) Blood 2) Semen 3) Vaginal secretions 4) Other blood contaminated fluid

Clinical Medicine II (9 decks)

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