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Flashcards in Virology: Clinical Vignettes Deck (128):




The capsid of a virus with helical symmetry is composed of
A. multiple identical copies of a single polypeptide molecule.
B. several polypeptides produced by sequential processing of a single large protein molecule.
C. several different polypeptides encoded by different open reading frames in the viral genome.
D. several different polypeptides generated by differential splicing of the same RNA transcript.
E. each of the above occurs and is characteristic of the specific virus family.

Correct answer = A. B, C, and D each occur in families with icosahedral symmetry, but helical capsids are composed of only one species of polypeptide, encoded by a single gene. In contrast, none of those with icosahedral symmetry have only a single polypeptide species.


The term eclipse period refers to
A. the period between epidemic outbreaks of diseases that occur in a cyclic pattern.
B. the period between recurrences of disease in individuals with latent virus infections.
C. the time between exposure of an individual to a virus and the first appearance of disease.
D. the time between infection of a susceptible cell by a cytocidal virus and the first appearance of cytopathic effects (CPE).
E. the time between entry into the cell and disassembly of the parental virus and the appearance of the first progeny virion.

Correct answer = E. C: This time is referred to as the incubation period. There is no specific term applied to the time periods described by A, B, and D.


The early genes of DNA viruses code primarily for proteins whose functions are required for
A. transcription of viral mRNA.
B. translation of the capsid proteins.
C. replication of the viral DNA.
D. final uncoating of the infecting virions.
E. processing of the mRNA precursors

Correct answer = C. Depending on the virus family, this may consist of a DNA polymerase and other enzymes directly involved in DNA replication or, alternatively, may be a product that stimulates the cell to produce all of the enzymes and precursors needed for DNA synthesis. A: Transcription for the most part is carried out by cellular RNA polymerase. B: Similarly, translation is done with the cell's translation system. D: The poxviruses do code for proteins that are involved in completion of uncoating, but this is an exception. E: mRNA processing is accomplished by cell enzymes.


An important step in the mechanism proposed for oncogenesis by human papillomaviruses is
A. inactivation of a cellular regulatory gene by HPV integration into the coding region of the gene.
B. transactivation of a normally silent cellular oncogene by an HPV early protein.
C. reversal of keratinocyte differentiation caused by continued active replication and production of progeny HPV.
D. specific binding of certain HPV early proteins to cellular anti-oncoproteins.
E. induction of a specific chromosome translocation that results in activation of a cellular oncogene.

Correct answer = A. The appearance of the rash coincides with production of antibodies to B19, which occurs several days after the peak of viremia. B: Infection in immunodeficient individuals can lead to chronic, progressive depletion of erythrocyte precursors and severe anemia, but not rash. C: The host range of B19 is restricted to erythroid precursors, including those found in the fetal liver. Whereas this may be a factor in causing hydrops fetalis due to B19 infection of a pregnant woman, it is not related to the rash. D and E: Again, B19 is not known to infect other than erythroid precursor cells.


The characteristic spectrum of diseases caused by autonomous parvoviruses is related to the fact that they
A. integrate into a specific chromosomal site that disrupts an essential gene and leads to death of the cell.
B. require host cells that are actively progressing through the mitotic cycle.
C. infect only terminally differentiated cells.
D. code for an early protein that shuts off cellular protein synthesis.
E. increase the severity of the disease normally caused by their associated helper virus.

Correct answer = B. The diseases caused by the autonomous parvoviruses all result from the effects of killing multiplying cells that are essential for normal functions; for example, B19 specifically infects erythroblasts, leading to anemia in the fetus or in immunodeficient patients. A, C, D: Parvoviruses are not observed to integrate during the replicative cycle, they cannot replicate in terminally differentiated cells, and they do not shut off cell syntheses. E: By definition, the autonomous parvoviruses do not require a helper virus for replication.


The characteristic rash of erythema infectiosum is due to

A. virion/antibody immune complex formation.
B. bone marrow suppression caused by killing of erythrocyte precursors by B19 infection.
C. damage to the liver.
D. B19 infection of epithelial cells.
E. the inflammatory response to B19 infection of capillary endothelium.

Correct answer = D. The early proteins of both adenoviruses and papovaviruses required for immortalization and transformation of normal cells have been shown to bind specifically to cellular proteins p53 and pRb, which are important in maintaining regulation of the mitotic cycle. Interaction with viral proteins is believed to result in loss of their normal functions, as do the mutations that are commonly associated with spontaneously occurring cancers. A, B: Neither gene inactivation by integration nor transcriptional activation by an early protein has been observed. C: Virus replication occurs only in differentiated keratinocytes, but dedifferentiation does not occur. E: Multiple chromosome rearrangements are observed late in progression to malignancy, but none are specific for HPV-transformed cells.


The initial infection with human cytomegalovirus most commonly occurs
A. during early childhood, by exchange of body fluids.
B. in utero, by transplacental transmission from a latently infected pregnant woman.
C. by transfer of saliva between young adults.
D. by sexual intercourse.
E. as a result of blood transfusion or organ transplantation.

Correct answer = C. The specificity of acyclovir derives from the fact that it must be phosphorylated by the HSV or VZV thymidine kinase to be an active inhibitor of viral DNA synthesis. HCMV does not have a corresponding enzyme. A: HCMV develops resistance to those drugs that are effective, such as ganciclovir and cidofovir, after long term therapy, but because their mechanisms of action are different, mutants resistant to one are usually not resistant to the other. B: All herpesviruses code for their own DNA polymerase. D: In those cases where access is a problem for treatment of herpesvirus infections, direct inoculation of the drug has been done. E: Resistance to antiherpesvirus drugs has generally involved mutation of the enzyme interacting with the drug, not inactivation of the drug.


The cellular response typical of infectious mononucleosis caused by Epstein-Barr virus is due to:
A. stimulation of B-cell proliferation by the EBV early proteins synthesized in the infected cells.
B. proliferation of cytotoxic T cells responding to EBV antigens expressed on the surface of infected B cells.
C. a primary humoral immune response to the EBV infection.
D. macrophages responding to the death of EBV-infected cells.
E. activation of an oncogene resulting from a chromosome translocation in EBV-infected lymphocytes.

Correct answer = A. Depending on the population, up to ninety percent have antibody by adulthood. B: The most serious complications of infection are those resulting from transplacental transmission, but this is not the common mode of transmission. C and D: Transmission by kissing or sexual intercourse can occur, but most individuals have already been infected by this age. E: This mode of transmission has serious consequences in antibody-negative recipients, but most recipients had been infected at an earlier age. More common is reactivation of latent HCMV in recipients who have been immunosuppressed for purposes of transplantation.


Acyclovir is largely ineffective in the treatment of human cytomegalovirus infections because
A. HCMV exhibits a high rate of mutation in the target enzyme.
B. HCMV depends upon the host cell's DNA polymerase for replication of its DNA.
C. HCMV lacks the thymidine kinase required for activation of acyclovir.
D. The tissues in which HCMV multiplies are largely inaccessible to the drug.
E. HCMV codes for an enzyme that inactivates the drug.

Correct answer = B. A: Polyclonal stimulation of B cells by EBV infection occurs, and results in appearance of the characteristic “heterophile antibodies,†but it is the CTL response that comprises atypical lymphocytosis of IM. C: EBV-specific humoral immune response is not related to lymphocytosis. D: B cells are not killed by infection with EBV. E: Whereas this is the process that results in EBV-associated Burkitt lymphoma, it occurs only years after the initial virus infection.


Killing of liver cells infected with hepatitis B virus is primarily caused by
A. shut-off of cellular protein synthesis.
B. intracytoplasmic accumulation of HBV antigen aggregates.
C. degradation of cellular mRNA.
D. attack by cytotoxic T lymphocytes directed against HBV antigens.
E. virus-induced aberrant chromosome rearrangements and deletions.

Correct answer = D. There is no evidence that HBV infection is cytocidal. Protein synthesis is not shut off, and mRNA is not degraded in infected cells. Accumulation of HBV proteins is not observed, rather they are actively exported. Whereas chromosome damage is observed in cells of primary hepatocellular carcinoma, it is not characteristic of nonmalignant infected liver cells.


The most common natural mode of transmission of infection with hepatitis B virus is via
A. contaminated water supply.
B. body fluids, such as urine and semen.
C. respiratory droplets.
D. direct contact.
E. infected insect vectors.

Correct answer = B. HBV is found at high levels in all body fluids, which results in transmission from mother to newborn, from sibling to sibling, through sexual intercourse, and by infection by virus-containing blood. Contaminated water or food is the typical source of HAV and HEV infection.


Hepatitis delta virus is unique in that
A. infectivity requires an envelope protein provided by a helper virus.
B. it has an RNA genome that is replicated by a replicase supplied by a coinfecting helper virus.
C. its mRNA is transcribed by a transcriptase supplied by a helper virus.
D. the virion contains a reverse transcriptase provided by a helper virus.
E. it encodes a protein (HDAg) that replaces helper virus glycoproteins in the envelopes of helper virus particles.

Correct answer = A. The only function of the HBV helper is to supply the envelope. B: Genome replication requires a cell RNA polymerase, presumably modified by the HDV delta protein such that it can use the HDV RNA as a template. C: Transcription likewise depends on cell enzymes. D: The virion contains only the delta protein. E: HDAg is complexed with the RNA genome in the HDV virion and is not found in the HBV virion.


A company held an elaborate holiday dinner party for its 42 employees. Within three to four weeks, many of the banquet attendees complained of experiencing fatigue, fever, nausea, and dark urine, and were observed to be jaundiced. The group exhibited no bacterial infections in common. The employees who became ill had all eaten raw oysters at the party. The company doctor assayed a sample of the employees' blood for anti-hepatitis B antibodies, but all samples were negative for anti-HBsAg IgM. The causative agent consistent with this history is most likely:
A. hepatitis A virus.
B. hepatitis B virus.
C. hepatitis C virus.
D. hepatitis D virus.
E. hepatitis E virus.

Correct answer = A. Hepatitis A is transmitted by the fecal-oral route and is most frequently acquired by eating contaminated shellfish or by contact with a carrier. The symptoms that were exhibited by the party-goers are consistent with liver damage caused by, for example, hepatitis. Hepatitis B infection is excluded because of the negative test for antibodies. Hepatitis C infection is acquired most commonly by IV drug users, patients on dialysis, and individuals obtaining tattoos. Hepatitis D infection occurs only in combination with hepatitis B infection. Hepatitis E is a major cause of enterically transmitted, water-borne hepatitis in developing countries.


Match the appropriate virus from the following list with the statement to which it most closely corresponds. Each virus can match one, more than one, or none of the statements.
A. Hepatitis A virus (HAV)
B. Coxsackie viruses
C. Hepatitis C virus (HCV)
D. Hepatitis E virus (HEV)
E. Yellow fever virus
F.Rubella virus

Intravenous drug users are at high risk for the virus

Correct answer = C. Until the recent development of tests for the presence of HCV in blood, HCV was an important cause of transfusion-associated hepatitis. IV drug users are one of several groups still at high risk for infection with this virus.


Match the appropriate virus from the following list with the statement to which it most closely corresponds. Each virus can match one, more than one, or none of the statements.
A. Hepatitis A virus (HAV)
B. Coxsackie viruses
C. Hepatitis C virus (HCV)
D. Hepatitis E virus (HEV)
E. Yellow fever virus
F. Rubella virus

Infection is caused by the bite of an infected mosquito

Correct answer = E. Yellow fever virus is an arthropod-borne virus, which is transmitted by the bite of an infected Aedes aegypti mosquito. The virus does not spread from person to person.


Match the appropriate virus from the following list with the statement to which it most closely corresponds. Each virus can match one, more than one, or none of the statements.

A. Hepatitis A virus (HAV)
B. Coxsackie viruses
C. Hepatitis C virus (HCV)
D. Hepatitis E virus (HEV)
E. Yellow fever virus
F. Rubella virus

Predisposes to hepatocellular carcinoma

Correct answer = C. Unlike HAV, HCV infection has a strong tendency to lead to a chronic hepatitis and cirrhosis, often resulting after many years in hepatocellular carcinoma.


Match the appropriate virus from the following list with the statement to which it most closely corresponds. Each virus can match one, more than one, or none of the statements.

A. Hepatitis A virus (HAV)
B. Coxsackie viruses
C. Hepatitis C virus (HCV)
D. Hepatitis E virus (HEV)
E. Yellow fever virus
F. Rubella virus

Causes congenital malformations

Correct answer = F. Infection with rubella virus is generally of little consequence to the adult. The exception is the pregnant woman, in whom rubella virus infection can result in congenital malformations in the fetus. The risk is highest in the first trimester. These malformations can affect the CNS, the liver, the heart, and the eye.


Current approaches to therapy of AIDS involve the use of multiple drugs because
A. it is not known which one will be effective.
B. mutants resistant to any one drug appear rapidly, but the chance for appearance of mutants resistant to all of them is small.
C. all inhibit the same step in replication, thereby increasing their effectiveness.
D. this is the most effective means of curing cells of integrated HIV genomes.
E. each tends to neutralize the toxicity of the others.

Correct answer = B. The major problem with chemotherapy of AIDS is the high mutation rate of the virus, leading to rapid appearance of mutants resistant to any single drug. By choosing drugs that act at different steps in the replication cycle or with different mechanisms of action, mutations in each of the affected proteins would have to occur in the same virus genome. The chance for this to occur is considerably lower than for either one individually. D: There is no way known to cure cells of their integrated genomes. E: Whereas these drugs do not neutralize each other's toxicity, it is possible in some cases to use a lower dose of each of the drugs, decreasing the toxic adverse effects.


The "asymptomatic period" following the initial acute disease caused by HIV infection is characterized by
A. high levels of HIV replication in lymphoid tissue.
B. high levels of HIV replication in circulating T lymphocytes.
C. inability of the immune system to respond to antigenic stimuli.
D. absence of detectable HIV genomes or mRNA in circulating lymphocytes.
E. high titers of free virus in the blood.

Correct answer = A. During this period, a relatively large fraction of circulating lymphocytes can be shown to contain integrated HIV genomes, but a considerably smaller fraction have HIV mRNA, and virus replication occurs in relatively few cells. Infectious virus is largely confined to the lymphoid organs, although occasional bursts of viremia do occur, usually as the result of antigenic stimulation. The immune system retains its ability to respond to mitogenic stimuli generally, but there is some impairment of responses to specific antigens.


After infection of a cell by a retrovirus, synthesis of progeny genomes is carried out by
A. the DNA-dependent RNA polymerase activity of viral reverse transcriptase.
B. the retrovirus RNA-dependent RNA polymerase.
C. the host-cell DNA polymerase.
D. a host-cell RNA polymerase.
E. a complex of reverse transcriptase and a second virus protein that enables it to synthesize RNA rather than DNA.

Correct answer = D. Progeny virus RNA is synthesized by the same transcription process as that of cellular genes. A and E: Reverse transcriptase is involved only in the initial step, converting the infecting parental RNA genome into dsDNA. B: Unlike other RNA viruses, retroviruses do not encode an RNA-dependent RNA polymerase. C: The host cell DNA polymerase replicates the integrated provirus, but plays no role in synthesis of progeny.


An ornithologist was on a three-month trip to study several species of birds living in a rain forest in South America. On the tenth day of her trip, she was bitten on the hand by an unusually aggressive bat. The scientist applied a topical antibiotic ointment and continued her research. Four weeks later, the scientist lost feeling in her hand. She shortly began experiencing high fever, periods of rigidity, difficulty in swallowing liquids, drooling, and disorientation. Death followed rapidly. A postmortem biopsy of her brain showed the presence of Negri bodies. These symptoms are consistent with the woman having died of
A. California encephalitis virus.
B. hantaan virus.
C. ebola virus.
D. rabies virus.
E. lymphocytic choriomeningitis virus.

Correct answer = D. Rabies virus is usually transmitted via the bite of an infected animal, and the woman's symptoms are consistent with those of rabies. California encephalitis virus, transmitted by arthropods, causes meningitis and encephalitis. Hantaan virus is transmitted through aerosols formed from dried rodent excretions. This virus causes hemorrhagic fever and severe pulmonary infections. Ebola virus can be transmitted by an animal, but infection causes severe hemorrhagic fever. Lymphocytic choriomeningitis virus is a cause of viral meningitis and a relatively benign infection with little mortality. Humans are infected by inhaling contaminated aerosols, or eating food containing viral particles, or by exposure of open wounds to infected soil.


From 1918 until 1956, the only subtype of influenza observed in humans was H1N1. In 1957, H1N1 was replaced by H2N2. This is an example of
A. viral interference.
B. phenotypic mixing.
C. antigenic shift.
D. antigenic drift.
E. viral transformation.

Correct answer = C. A marked antigenic change in the N protein, the H protein, or both is termed antigenic shift. In antigenic drift, there is also an antigenic change in one or both of these proteins, but the change is much less significant. With antigenic drift, although the H protein does change antigenically, H1 remains H1, for example.


The typical clinical syndrome associated with rotavirus infection is
A. acute gastroenteritis of young adults.
B. acute bronchiolitis of infants.
C. acute hepatitis.
D. nausea, vomiting, and diarrhea in infants and young children.
E. acute paralytic syndrome.

Correct answer = D. Rotaviruses infect and replicate in the gastrointestinal tract and typically affect infants and very young children. Although rotavirus infections are seen world-wide, there is significant mortality only in developing countries or in situations where good medical treatment (for example, fluid and electrolyte replacement), is not available.


Rotaviruses differ from polioviruses in that rotaviruses
A. infect via the fecal-oral route.
B. lack an envelope.
C. can undergo genetic reassortment.
D. do not contain any enzymes.
E. have an icosahedral structure.

Correct answer = C. Because rotaviruses contain a segmented genome, infection of a single cell with two different rotaviruses can result in genetic reassortment and the emergence of a new viral strain with some genomic segments from one parent and the remaining genomic segments from the other parent. Rotaviruses do contain the enzymes required to synthesize viral mRNAs. A, B, D, E: There are no differences between polioviruses and rotaviruses in these characteristics.


The diagnosis of a rotavirus infection
A. can be made, in most cases, on the basis of the clinical presentation.
B. can be made on the basis of an increase in antibody titer.
C. is routinely made by electron microscopy of suitably treated stool samples.
D. can only be made on epidemiologic grounds (for example, if there is an epidemic).
E. must be made rapidly so that specific antiviral therapy is initiated as soon as possible.

Correct answer = B. The diagnosis of rotavirus infection is readily made by serology (that is, by demonstrating a rise in antibody titer). There are also several tests available by which rotavirus antigens can be demonstrated in the stool. Although the diagnosis can be made by electron microscopy, it is not a routine procedure. The clinical presentation is not sufficiently distinctive to make the diagnosis, and there is no specific antiviral treatment for rotavirus infections.


A patient with symptoms of Creutzfeldt-Jacob disease caused by eating contaminated beef would most likely exhibit which of the following
A. circulating antibodies specific for bovine CNS antigens.
B. DNA copies of the bovine infectious agent integrated into chromosomes of the patient's diseased CNS tissue.
C. cytotoxic T lymphocytes directed against CNS-specific antigens found in both cattle and humans.
D. amyloid deposits that have bovine rather than the human amino acid sequences.
E. lack of any bovine-specific protein or nucleic acid or an immune response.

Correct answer = E. A and C: An important characteristic of the prion diseases is that there is no unique immune response to either the prion or to CNS antigens. B: A second distinguishing feature of these agents is the absence of a detectable nucleic acid genome. D: The amyloid deposits found in these diseases are composed of the diseased host's proteins, and not of proteins from the source of the infection.


What degree of HSV resistance to acyclovir is seen in the US population?

Depend on the host


Asymptomatic shedding of HSV-2 occurs in what percentage of days out of a year?



What antiviral drug is active against CMV?



How are the asymptomatic HIV patients screen for CMV?

Eye exams every 6 months while the CD4 count is less that 50


What is the appropriate initial clinical management of AIDS?

Symptomatic therapy


The term "retrovirus" refers specifically to the presence of ____?

Reverse transcriptase


What measures can be protective against the acquisition of West Nile virus?

Mosquito repellant


What host factor is most strongly linked to increased morbidity and mortality of WNV encephalitis?

Older age


A 41 year old man presents to the ER with the sudden onset of anorexia, abdominal pain, nausea, and dark urine. He lives with his wife and 2 year old son who is in day care, neither of whom are ill. He works as a phlebotomist at your hospital and has been successfully immunized for Hep B. He drinks one glass of wine daily with dinner and denies IVDU. He takes no medications. On exam he is afebrile with obvious scleral icterus, mild jaundice, and RUQ tenderness. Labs show normal CBC and creatinine, AST, ALT, total bilirubin, Alkaline phosphataste. What is the most likely source of his infection?



A healthy 35 year old woman is going to a remote village in Mexico for hiking in 2 weeks. She has no history of Hep A disease or vaccination. What strategy for prevention of Hep A is appropriate?

Both Hep A vaccine and serum Ig


What serologic marker shows immunity to HBV?



What HIV drug is also active against HBV?

3TC (lamivudine)


Ribavirin can treat certain hemorrhagic fever viruses as well as severe cases of RSV. It is also a mainstay of treatment of ___?

Hep C


A previously healthy 28 year old woman goes camping in New Mexico and develops a fever and sever pulmonary edema requiring intubation. She should be evaluated for ____?

Sin Nombre virus


A 29 year old confined to bed with headache, fatigue, and high fever most likely has?



Which enzyme is inhibited by zanamivir?



What is a contraindication to influenza vaccination?

Allergy to eggs


What drug is active against influenza B?



Which of the following is not an RNA virus?

B. Measles virus
C. Rubella virus
D. Hep B
E. Hep C

Hep B


A woman in he 1st trimester of pregnancy is known to be rubella non-immune. She is inadvertently exposed to an active case of rubella through a coworker's child. What is the most appropriate course of action?

Simultaneously determine rubella Ab titers on specimens obtained 2 to 4 weeks apart during pregnancy to determine risk to the fetus


What patients should not be offered a rubella vaccine?

The husband of a woman in her first trimester of pregnancy; neither parent has detectable rubella Abs.


A 25 year old medical student develops rhinorrhea, sneezing, nasal congestion, and mild sore throat, while her family medicine rotation in January. She has no fever, headache, or myalgia. What is the most likely cause of her symptoms?



A 23 year old man presents with acute onset of dysuria, gross hematuria, and suprapubic pain of 2 day duration. He has no fever. BP and creatinine are normal. UA shows 3+ hemoglobin, no leukocyte esterase. Microscopic exam of the urine shows numerous RBC's of normal morphology. Routine culture is negative. CT scan of the abdomen is completley normal. His symptoms continue for 3 more days, and then spontaneously subside. What was the cause of his illness?



T/F: OPV has the advantage of secondary immunization of non-immune contacts through the shedding of vaccine virus into the intestinal tract.



A previously healthy 20 year old college lacrosse player develops SOB, chest pain, and fatigue several days after an upper respiratory infection. On exam, she is in atrial fibrillation and mild congestive heat failure. Chest x-ray shows an enlarged heart and mild pulmonary edema. What is the most likely infectious cause of her symptoms?

Myocarditis bue to Coxsackie B virus


Which of the following statements about clinical viral disease is true?
(A) It is most frequently due to toxin production.
(B) It usually follows viral infection.
(C) It can result without infection of host cells.
(D) It is associated with target organs in most disseminated viral infections.

D. Many viral infections are asymptomatic or subclinical. Clinical disease, however, is often associated with viral replication in target organs during disseminated viral infections.


The eclipse period of a one-step viral multiplication curve is defined as the period of time between the
(A) uncoating and assembly of the virus.
(B) start of the infection and the first appearance of extracellular virus.
(C) start of the infection and the first appearance of intracellular virus.
(D) start of the infection and uncoating of the virus.

C. The period of time between the adsorption and penetration of the virus until the first appearance of intracellular virus is the eclipse phase.


Which of the following is the most frequent cause of blood transfusion associated hepatitis?
(A) Hepatitis A virus
(B) Hepatitis B virus
(C) Hepatitis C virus
(D) Hepatitis D virus

C. Hepatitis can be transmitted by both the oral and parenteral routes; hepatitis C virus is the virus most associated with hepatitis following the transfusion of blood products.


Antiviral capsid antigen (VCA) antibodies are found in
(A) cytomegalovirus infections.
(B) Epstein-Barr virus infections.
(C) herpes simplex virus infections.
(D) varicella-zoster virus infections

B. Antibodies to the viral capsid antigen (VCA) are important in identifying Epstein-Barr virus infections.


Passive immunization is available for protection from
(A) influenza A virus.
(B) hepatitis A virus.
(C) parainfluenza type 2 virus.
(D) rubella virus.

B. A commercially available human immune globulin preparation is available for pre- and postexposure prophylaxis for hepatitis A virus.


Linear, single-stranded DNA is the genetic material of
(A) caliciviruses.
(B) flaviviruses.
(C) papovaviruses.
(D) parvoviruses.

D. Parvoviruses have linear, single-stranded DNA while papovaviruses have circular, double-stranded DNA. Caliciviruses and flaviviruses are RNA viruses.


Infantile diarrhea is usually attributable to
(A) adenovirus.
(B) coronavirus.
(C) Norwalk virus.
(D) rotavirus.

D. Although adenoviruses, Norwalk virus, and rotaviruses can cause diarrhea, infantile diarrhea is usually caused by rotaviruses.


Which of the following is an RNA virus that has a nuclear phase to its replication process?
(A) Coronavirus
(B) Rhabdovirus
(C) Retrovirus
(D) Togavirus

C. The reverse transcriptase of retroviruses makes a DNA copy of the genomic RNA. This DNA must be integrated into the host-cell DNA in the nucleus for the remaining steps in the replication process to occur.


Negri bodies are associated with
(A) cytomegalovirus infections.
(B) herpes simplex virus infections.
(C) rabies virus infections.
(D) rubella virus infections.

C. Negri bodies are intracytoplasmic inclusion bodies found in rabies virus nfected neurons and are important in the diagnosis of infected animals.


Persistent virus infections
(A) are usually confined to the initial site of infection.
(B) are preceded by acute clinical disease.
(C) elicit a poor antibody response.
(D) may involve infected carrier individuals.

D. Some persistent virus infections, such as serum hepatitis caused by hepatitis B virus, involve carrier individuals who may or may not have clinical signs of the disease.


Which of the following is an example of a killed virus vaccine?
(A) Jeryl Lynn mumps vaccine
(B) Enders measles vaccine
(C) Salk poliovirus vaccine
(D) Oka varicella-zoster vaccine

C. Although many of the childhood vaccines like measles, mumps, and chickenpox contain live, attenuated virus, the Salk poliovirus vaccine contains killed virus.


Which of the following is the first viral-induced defense mechanism in a nonimmune individual?
(A) Generation of cytotoxic T lymphocytes
(B) Production of interferon
(C) Synthesis of lymphokines
(D) Synthesis of neutralizing antibodies

B. The production of interferons that induce the synthesis of antiviral replication proteins in neighboring cells occurs before the appearance of any other viral-induced immune defense mechanisms.


Localized viral disease
(A) is a major feature of congenital viral infections.
(B) is associated with a pronounced viremia.
(C) can be associated with carrier individuals.
(D) may have systemic clinical features such as fever.

D. Although localized infections are not associated with pronounced viremia, they can have clinical features similar to viremic systemic infections.


Viral-induced heart disease is most frequently associated with
(A) arenavirus infections.
(B) coxsackievirus infections.
(C) echovirus infections.
(D) enterovirus infections.

B. Coxsackie B viruses are cardiotrophic and infect myocytes.


Where are viral oncogenes found?
(A) JC virus
(B) Human T-cell lymphotrophic virus type I
(C) Rous sarcoma virus
(D) Simian virus 40

C. Viral oncogenes are found in many RNA tumor viruses. Both Rous sarcoma virus and human T-cell lymphotrophic virus type I are RNA tumor viruses, but only Rous sarcoma virus carries an oncogene (v-src).


Dane particles are associated with
(A) hepatitis A virus.
(B) hepatitis B virus.
(C) hepatitis C virus.
(D) hepatitis E virus.

B. The spherical virion of hepatitis B virus is called the Dane particle.


Which of the following terms refers to the exchange of homologous segments of RNA between two different influenza type A viruses?
(A) Complementation
(B) Genetic reassortment
(C) Phenotypic masking
(D) Phenotypic mixing

B. Genetic reassortment is the name given to the process whereby homologous pieces of RNA are exchanged between two different strains of influenza viruses replicating in the same cell.


Which of the following is a virus that may cause a winter illness characterized by red blood cells in the cerebrospinal fluid and temporal lobe dysfunction?
(A) Coxsackie A virus
(B) Herpes simplex virus
(C) Poliovirus
(D) Western equine encephalomyelitis virus

B. Herpes simplex virus causes an encephalitis that localizes within the temporal lobe; western equine encephalomyelitis virus requires a mosquito vector and would not be observed during the winter months.


Subacute sclerosing panencephalitis is a slowly progressive, degenerative neurologic disease associated with
(A) herpes simplex virus infection.
(B) measles virus infection.
(C) mumps virus infection.
(D) varicella-zoster virus infection.

B. Subacute sclerosing panencephalitis is a late (10 or more years) complication of measles caused by a defective virus variant of the original infecting measles virus.


Which of the following is a virus infection involving the presence of a noninfectious form of the virus?
(A) Abortive
(B) Latent
(C) Persistent
(D) Subclinical

B. Some viruses, such as herpes simplex virus, can exist as noninfectious forms in the same cells of the body and later convert (reactivate) to infectious forms that cause disease.


The nanogram level of antigen in serum is detected by
(A) dot blot tests.
(B) enzyme-linked immunosorbent assay.
(C) fluorescent antibody staining.
(D) protein-protein hybridization tests.

B. Enzyme-linked immunosorbent assay (ELISA) is the most sensitive method of detecting antigens in the serum.


Which of the following is a virus that infects and lyses progenitor erythroid cells causing aplastic crises in patients with hemolytic anemia?
(A) California encephalitis virus
(B) Epstein-Barr virus
(C) Parvovirus B19
(D) Yellow fever virus

C. The target cells of human parvovirus B19 are progenitor erythroid cells; infections in patients with hemolytic anemia can be serious.


Which of the following is a viral protein that is thought to induce tumors by binding to a cellular tumor suppressor protein?
(A) Adenovirus E1A
(B) Epstein-Barr nuclear antigen proteins
(C) Hepatitis B virus e protein
(D) Human immunodeficiency virus gag protein

A. In permissive cells, adenovirus E1A protein is involved in the replication process, but in nonpermissive cells it can bind to cellular tumor suppressor protein p110Rb and inactivate its normal cellular function, which results in cellular transformation.


Viruses whose genomes have messenger (positive-sense) polarity are
(A) adenoviruses
(B) papovaviruses
(C) paramyxoviruses
(D) polioviruses

D. The genetic material of poliovirus is single-stranded RNA, which can be translated into a large polyprotein that is subsequently cleaved into the individual viral proteins.


Antiviral nucleoside analogues
(A) are effective only against replicating viruses.
(B) include foscarnet.
(C) inhibit replicases.
(D) may block viral penetration.

A. Nucleoside analogues inhibit viral replication by inhibiting viral DNA synthesis or function; they do not affect RNA replicases or block penetration.


A commercial vaccine consisting of virion subunits prepared by recombinant technology exists for
(A) hepatitis B virus.
(B) rabies virus.
(C) rotavirus.
(D) varicella-zoster virus.

A. Both the Recombivax-HB and Engerix-B vaccines for protection from hepatitis B virus contain the virus surface antigen prepared from yeast using recombinant DNA technology.


Which of the following causes a nosocomial infection with the potential to cause serious respiratory disease in an infant pediatric ward?
(A) Adenovirus
(B) Picornavirus
(C) Coxsackie A virus
(D) Respiratory syncytial virus

D. Respiratory syncytial virus is a serious respiratory disease pathogen for infants and has been associated with hospital-acquired (nosocomial) infections.


37 y.o. man with painful penile ulcer for a week. Over last 2 months, experienced malaise and blurry vision. Wife is only sexual partner- she is being treated for HIV. Retinal exam reveals “Flame retinitis.”
Most common cause of penile ulcers in US?
B. Adenovirus
C. Histoplasma capsulatum
D. Leishmania
E. Herpes Simplex virus

E. Herpes Simplex virus

Though the most common, HSV is not always the culprit for penile ulcers.


How to make the most definitive diagnosis of HSV for a patient with a penile ulcer?
A. Biopsy of lesion with visualization of cyto viral inclusions
B. IgM serology
C. DFA of ulcer material looking for viral antigens
D. Geisma stain of ulcer scraping
E. Empiric therapy with anti-viral therapy to test for response.

C. DFA of ulcer material looking for viral antigens

Viral PCR also an acceptable answer.
-DFA- Drag Farson antibody test.


How is the herpes virus transmitted?
A. Airborne
B. Droplet transmission from skin ulcers
C. Skin Contact with someone with mucosal virus
D. Bloodborne transmission
E. Foodborne

C. Skin Contact with someone with mucosal virus


What is the treatment for Herpes virus infections?
A. interferon alpha + ribavirin
B. Valacyclovir
C. Oseltamavir
D. Amphotericin
E. IV Ig against virus

B. Valacyclovir


How to prevent Herpes transmission?
A. IV Ig against virus
B. Spermicidal jelly
C. Famciclovir
D. Abstinence
E. Diaphragm use

D. Abstinence


How is a diagnosis of CMV made for a patient with a presentation of “flame” or “ketchup and mustard” retinitis?
A. Biopsy of lesion
B. IgM serology
D. Giesma stain of lesion looking for antigens
E. Empiric therapy with anti-viral therapy to test for response.

E. Empiric therapy with anti-viral therapy to test for response.

Can sample vitreous jelly for PCR to look for CMV
Treat first and see how they do with treatment, then try something else if it doesn’t get better.


How can a patient NOT get CMV retinitis?
A. Airborne
B. Contact with infected body fluids (ingestion/mucosal)
C. Contact transmission from someone with mucosal virus
D. Bloodborne transmission from viremic person
E. Placental transmission

A. Airborne

All other choices are possible ways to contract CMV: blood donation, sexual transmission, breast milk transmission to neonate, placental…


How is CMV retinitis treated?
A. Interferon alpha and ribavirin
B. Valacyclovir
C. Zanamivir
D. Ganciclovir
E. I.V. Ig against virus

D. Ganciclovir

You must recognize that CMV is a different type of virus than the other Herpes viruses, so some form of Ganciclovir is the best choice.
-This drug can ALSO treat HSV


How is CMV retinitis prevented?
A. I.V. Ig against virus
B. Spermicidal jelly
C. Valacyclovir
D. Abstinence
E. None of the above

E. None of the above

-Since CMV is so prevelent, it’s hard to not be infected with CMV. Some rural areas in Iowa have no CMV because they are so isolated and contain a stable, small population. These people are very susceptible to CMV disease during transplantation/blood transfusions due the fact that most people in the US donating these products are CMV positive.


How can a patient with a CMV reitinitis infection prevent another episode of this disease?
A. Taking long-term Valganciclovir
B. Sexual abstinence to avoid re-infection
C. Interferon alpha
D. Do nothing
E. Can’t prevent it.

A. Taking long-term Valganciclovir


Despite using Vanganciclovir, a patient with CMV retinitis gets worse. Now what?
A. Start Valacyclovir because it has better drug activity.
B. Add I.V. Ig because patient is lacking cytotoxic Ab
C. Start Foscarnet b/c it doesn’t require viral phosphorylation
D. IV acyclovir
E. Remove the eyeball

C. Start Foscarnet b/c it doesn’t require viral phosphorylation


What is a possible cause for a severe case of CMV retinitis?
A. cyclic neutropenia
B. Bruton’s agammaglobulinemia
C. NK cell deficiency
D.IL-12 deficiency
E. T cell defiency

E. T cell defiency

This patient has HIV> particularly because of this infection he could be classified as having AIDS (CMV retinitis is an AIDS-defining condition)
-Transmission of HIV is easier if CMV disease has damaged the integrity of the mucosal barrier, allowing easier transmission of HIV from this guy’s wife.


18 y.o. Swiss college student with fever, “cold symptoms”, broke out with a rash all over her body. Complains also of cough.
Which of the following are not a cause of fever and rash in the US?
A. Parvovirus B19
B. Variola
C. HSV-6
D. Measles
E. West Nile Virus

B. Variola

You think it’s Variola, better call the CDC.
-heads up though, West Nile CAN cause a rash


How to best make a definitive diagnosis of measles?
A. biopsy of lesion to visual cellular inclusions
B. Igm serology
C. DFA of ulcer material looking for viral Ag
D. Geisma stain of buccal scraping
E. Empiric therapy with anti-viral therapy to see if patient has a response.

B. Igm serology
Measles- look for confluent, macular rash associated with fever and cold-like illness.
-in mouth, see macular lesions.


How do patients contract Measles?
A. Airborne transmission from someone with viral infection prior to rash presentation
B. Droplet transmission from someone infected, but after their rash is gone.
C. Contact transmission from someone with mucosal virus without symptoms
D. Bloodborne
E. Foodborne.

A. Airborne transmission from someone with viral infection prior to rash presentation

Once rash is gone, you are no longer infectious.
You are, however, contagious prior to developing a rash.


How is measles treated?
A.Interferon alpha and ribavirin
B. Famciclovir
C. Fimantidine
D. Supportive care
E. I.V. Ig against virus

D. Supportive care


How is Measles transmission prevented?
A. I.V. Ig against virus
B. Vaccination with killed virus
C. Vaccination with live attenuated virus
D. Abstinence from sharing food
E. Excellent hand hygeine

C. Vaccination with live attenuated virus

Killed vaccine was tried first, but didn’t work very well- vaccinated individuals were developing weird, atypical measles presentations.
-Vaccine used now is LIVE, so immunocompromised individuals are susceptible to disease.


How can a patient who has had measles prevent another episode of this infection?
A. Do nothing- he has immunity from prior infection
B. Avoid infected individuals in the future
C. Can’t avoid it.
D. Take long-term I.V. Ig against virus
E. Interferon alpha

A. Do nothing- he has immunity from prior infection


What is the most likely cause of a SEVERE measles infection?
A. Cyclic neutropenia
B. Agammaglobulinemia
C. IL-12 deficiency
D. T cell deficiency
E. Malnutrition

E. Malnutrition

Malnutrition: Vitamin A deficiency is associated with deaths associated with measles


84 y.o. woman lives in assisted living facility presents with five day increasing dyspnea, low-grade fever, nausea and vomiting. Acute respiratory distress occurs associated with hypoxia. CTX- diffuse bilateral lower lobe infiltrate- pneumonia. What is most common VIRAL cause of severe pneumonia in the US?
B. Adenovirus
C. Influenza
D. Rhinovirus

C. Influenza

Flu is most common, followed by adenovirus.
-Rhinovirus is limited to upper respiratory tract.


How do you differentiate between Infleunza and adenovirus-associated pneumonias, and make a definitive diagnosis?
A. biopsy of lung
B. IgM serology
C. Rapid antigen testing from nasopharyngeal material looking for viral Ags
D. PCR of nasopharyngeal materal for specific viral nucleic acid
E. Empiric therapy to see if it works

D. PCR of nasopharyngeal materal for specific viral nucleic acid

Material must be gathered from posterior pharynx in order to make this PCR work.


How is influenza contracted?
A. airborne transmission of viral particles from someone with cold symptoms
B. Droplet transmission of viral particles from someone with cold symptoms
C. Contact transmission of virus particles from someone with mucosal virus
D. Bloodborne
E. Foodborne

B. Droplet transmission of viral particles from someone with cold symptoms

Case control studies show that droplet transmission occurs within six feet of source, then airborne any further than that.
-really it’s up in the air according to the literature (haha, no pun intended).
-Droplet precautions are sufficient when dealing with flu.
-Other flu viruses like avian (Bird) flu> if you’re swinging a dead chicken around your head, and then you inhale the airborne chicken poop, then you might get bird flu, according to the professor. Moral of the story, don’t swing dead chickens.


How is Influenza treated?
A. Interferon alpha and rivavirin
B. acyclovir
C. Oseltamivir
Supportive treatment only
IV Ig against virus

C. Oseltamivir

Oseltamivir is a good treatment EARLY in the influenza infection since it stops viral particles from leaving the cell by inhibiting neurominidase (remember, this protein cleaves sialic acid to let viral particles leave)


How can influenza transmission be prevented in elderly patients in an assisted care facility?
A. IV Ig against virus
B. Vaccination with killed/live attenuated virus
C. Use of face mask
D. Excellent hand hygeine
E. Vaccination AND oseltamivir if virus is sensitive

E. Vaccination AND oseltamivir if virus is sensitive

Issue is…How good is vaccination in the elderly? Is it sufficient?
-Vaccine responsiveness declines with age.
-Vaccines also are usually only 60% matches for the virus strains circulating in the population.
-Tamiflu resistant strains have already shown up> if the strain isn’t resistant, this is a good precaution.
-Life attenuated flu vaccines are not recommended for elderly patients since they may develop a vaccine-related illness that could push them over the edge.
-Live attenuated viruses used for young people afraid of needles.


Vaccination of the elderly for influenza is not 100% effective in New Orleans. Which of the following strategies might be better?
A. Vaccination of elderly with double-dose vaccine
B. Vaccination of those interacting with elderly, particularly children, famialy members, service workers
Long-term oseltamavir use during flu season
Masking of all residents and employees of care facilities during flu season
Passive immunization with flu-specific Igs

B. Vaccination of those interacting with elderly, particularly children, famialy members, service workers

Create a cone of protection around the elderly by vaccinating everyone around them, especially those pesky school-aged “virus bags,” A.K.A. children.
-Health care workers also need to be vaccinated not only to protect ourselves, but also our patients.


How can a patient with infleunza prevent another episode of this infection?
A. Do nothing- he has immunity
B. Practice excellent hand hygiene and cough etiquette
C. Do nothing- there is no way to prevent another infection
D. Take long-term zanamivir to suppress viral replication
E. Interferon alpha

B. Practice excellent hand hygiene and cough etiquette

Mutation rate and antigenic drift of HA and NA make for a new strain of flu every season, so no life-long immunity can be achieved to influenza.
-good health practices
-zanamivir- other NA inhibitor (like tamiflu) that is aerolized and must be inhaled.
-Don’t reuse tissues, cough into your elbow


Despite use of Tamiflu, an influenza patient worsens. What is the next step and why?
A. Start parental nutrition b/c malnutrition is the cause of the failure
B. Add IV Ig b/c patient is lacking cytotoxic Ab necessary to kill virally infected cells
C. Start rimantidine b/c it binds NA better than Tamiflu
D. Continue supportive care with careful attention to fluid balance, respiratory care, and infection prevention
E. Add GM-CSF to enhance phagocytic killing

D. Continue supportive care with careful attention to fluid balance, respiratory care, and infection prevention

Rimantidine- prevents uncoating of Flu A only, resistance is very common. Not useful.
Tamiflu= osaltamavir


CDC recommends yearly vaccination against influenza for everyone. Why?
A. Influenza is a uniformly lethal disease killing millions per year
B. Influenza wanes quickly b/c antigens used in vaccine are T-independent ones
C. Viral antigens change over time thus allowing the virus to evade established immunity.
D. Part of the federal plot to poison the population.
E. Viral antigens are poor Ig so yearly vaccinations are required to build immunity.

C. Viral antigens change over time thus allowing the virus to evade established immunity.


44 y.o. obese woman in ER during the summer for three day Hx of febrile illness with sore throat, dry cough, myalgia, diarrhea, and widespread erythmatous rash. CTX shows bilateral lower lobe infiltrates indicative of pneumonia. She’s had all of her vaccinations.
What is the most liklely viral cause of this pneumonia?
B. Adenovirus
C. Influenza
D. Rhinovirus
E. SARS-Coronavirus

B. Adenovirus

Influenza and adenovirus can both cause a rash, both cause a conjunctivitis
-Measles can also cause this but she’s been vaccinated.
-If she’s been to China and tasted some delicious civet cat- she might have SARS.
-younger person, summer time- think adenovirus, not flu.


How can a definitive diagnosis be made for adenovirus associated pneumonia?
A. Lung tissue biopsy
B. IgM serology
C. Rapid antigen testing of nasopharyngeal material looking for viral Ags
D. Culture of nasopharyngeal material looking for viral replication
E. Empiric therapy- see if it works.

C. Rapid antigen testing of nasopharyngeal material looking for viral Ags &
D. Culture of nasopharyngeal material looking for viral replication
Both of these methods are used, however, it depends on the methodology used to test for the virus: how is the virus sample obtained? How was the culture performed? How long did it take to process, etc… Culture is the gold standard, but PCR studies show that cultures miss the virus some times. Rapid testing is used at Children’s Hospital, and it’s widely used elsewhere.


How is adenovirus contracted?
A. Airborne from someone with cold symptoms
B. Droplet transmission from someone with cold symptoms
C. Contact with someone with mucosal virus infection
D. Bloodborne
E. Foodborne

B. Droplet transmission from someone with cold symptoms

Contact transmission also occurs since the virus can live for a while on surfaces> Don’t come to school with pink eye.


How is adenovirus treated?
A. Interferon alpha and ribavirin
B. Foscarnet
C. Oseltamivir
D. Supportive care only
E. IV Ig against virus

D. Supportive care only
There is no treatment for adenovirus.


How is adenovirus infection most effectively prevented?
A. IV IG against virus
B. Vaccination with killed or live attenuated virus
C. Use of face mask
D. Hand hygiene
E. C and D

E. C and D
Droplet and contact precautions


Most common cause of acute hepatitis in the US is…
B. Hepatitis B
C. Hepatitis C
D. Hepatitis A
E. Hepatitis D

B. Hepatitis B

ACUTE is the key word here. According to the CDC, Hep B is the most common cause of acute hep, though Hep A also causes it.


What is the most common cause of chronic hepatitis?
B. Hep A
C. Hep B
D. Hep C
E. Hep D

D. Hep C


How is a definitive diagnosis made for the cause of hepatitis?
A. Liver biopsy
B. Serum antigen testing looking for virus-specific Ag
C. Ab to virus-specific Ag
D. Serum Ag and Ab testing
E. Empiric therapy with anti-virals, look to see if it works.

D. Serum Ag and Ab testing

Hep B- look for surface antigens
Hep A and C- look for anti-core Ab
Do both, since different hepatitis viruses have different testable antigens/antibodies


How is Hepatitis B contracted?
A. Airborne transmission
B. Droplet transmission
C. Sexual contact with mucosal viral infection
D. Bloodborne transmission (IVDU)
E. Foodborne

C. Sexual contact with mucosal viral infection

IVDU- intravenous drug use
Hep B- sexually transmitted
Hep A- Food


What co-morbidity can worsen a Hepatitis B infection outcome?
A. HIV infection
B. Hep D
C. Hep A
D. Hep E
E. All of the above.

E. All of the above.

-Hep A and Hep D- If liver is already non-functional or diseased, adding another disease will make liver fail.
-Hep E is not in developed countries, but can make it worse.
-HIV- immune system is compromised
-Hep D is uncommon in US, but really common in Italy


How is acute Hepatitis with dual Hepatitis B and Hepatitis C infection treated?
A. Interferon alpha and ribavirin
B. Tenofovir and/or lamuvidine
C. Interferon alpha and ribavirin and tenofovir
D. Supportive care only
E. IV Ig against virus

C. Interferon alpha and ribavirin and tenofovir
Both diseases require a combination of therapies


How can Hepatitis virus infection be prevented?
A. Intramuscular Ig against virus
B. vaccination of against Hep C
C. Avoidance of IVDU
D. Sexual abstinance
E. Vaccination against Hep B, barrier sexual precautions, avoidance of contamination of blood products

E. Vaccination against Hep B, barrier sexual precautions, avoidance of contamination of blood products

Hep A- give immunoglobulin
Hep B- Vaccination, but watch out, some people don’t respond to the vaccine. When was the last time you checked your titer?


In a patient with dual viral hepatitis B and C infections, how can a second acute hepatitis episode be avoided?
A. Do nothing- infection has given him immunity
B. Practice safe sex to avoid reinfection
C. D and E
D. he can take long-term lamivudine to suppress viral replication
E. Interferon alpha to boost immune system

C. D and E

-Check for anti-surface antigen Antibody against Hep B> if it’s there, he’d have immunity.
-if surface antigen is present in the body, it means there’s no immunity.
-Vaccinated: surface antigen negative, core antibody negative, surface antibody positive VERY IMPORTANT!!!
-lamivudine works against B but not C


Patient with dual Hep C and B infections is given lamivudine, but only gets worse. What now?
A. Start tenofovir since there are some lamivudine resistant strains of the virus
B. Add IV Ig b/c patient may be lacking cytotoxic Ab necessary to kill virus-laden cells
C. Start cidofovir> doesn’t require viral phosphorylation
D. Add bocepravir to another round of interferon alpha and ribavirin to decrease viral replication
E. Add GM-CSF to enhance phagocytic killing

D. Add bocepravir to another round of interferon alpha and ribavirin to decrease viral replication

Bocepravir is a protease inhibitor, works well against Hep strains. It’s similar to some of the anti-HIV proteases.
Lamivudine gets the B under control, but Hep C is still destroying his liver.


How does HIV affect the outcome of a patient with acute hepatitis associated with dual Hep B and Hep C infections?
A. Hep C leads to T cell activation and thus accelerated HIV course
B. HIV leads to accelerated cirrhosis with Hep C
C. HIV leads to high Hep C viral load
D. HIV leads to poor response against Hep C
E. All of the above.

E. All of the above.


What is most likely cause for a severe Hepatitis B and C infection in an IV drug user?
A. Cyclic neutropenia
B. Deficiency in T cell count
C. NK cell deficiency
D. Agammaglobulinemia

B. Deficiency in T cell count
Using needle drugs- think possibility of HIV


Patient presents with dark, purple-ish flat lesions on the arm. What is the most likely cause of these lesions?
C. HHV-6
D. HHV-8

D. HHV-8


What is a possible viral cause of hairy leukoplakia of the tongue?
D. HHV-6
E. HHV-8



Patient presents with headaches for several weeks. Also has karposi’s sarcoma and hairy leukoplakia. Brain scan shows mass lesion with edema around it. What’s the most probable viral cause of this brain lesion?
E. HHV-6



What is the primary cell infected by EBV?
A. B cells
B. T cells
C. Epithelial cells
D. Hepatocytes
E. Glial cells

A. B cells


29 y.o. pregnant woman presenting with arthritis, photosensitivity, four year old at home has flu-like illness. What is the most-likely viral cause of her arthritis?
A. Parvovirus

A. Parvovirus