Virus 2

Question 1

Measles - spread through

Answer 1

respiratory droplets
shed before and after the onset of symptoms
most infections appear to be symptomatic
rash caused by immune response (CMI) to infected endothelial lining in the small BVs

Question 2

Measles clinical features - incubation period is

Answer 2

1 to 2 weeks

Question 3

Measles clinical features - prodrome

Answer 3

stepwise increase in fever to 103 or higher
cough, coryza, conjunctivitis
Koplik spots!

Question 4

Measles - koplik spots

Answer 4

small white spots on bright red mucus membranes of the mouth and throat

Question 5

Measles - clinical features - rash

Answer 5

2 to 4 days after prodrome, 14 days after exposure
Begins on face and hand and persists 2 to 6 days
Rash fades in order of appearance

Question 6

Measles complications

Answer 6

Diarrhea (8%)
Otitis media (7%)
Pneumonia (6%)
Encephalitis (0.1 to 0.5%)
Death (0.2%)
Hospitalization (18%)

Question 7

Measles complications - pneumonia accounts for __ deaths

Answer 7

60% of deaths caused by measles

Question 8

Measles complications - persistent diarrhea

Answer 8

major cause of mortality in children in underdeveloped regions

Question 9

Measles complications - post infectious encephalitis

Answer 9

Autoimmune in nature
Occurs in less than 1% of those infected more often in older children and adults
15% fatality rate

Question 10

Measles vaccine

Answer 10

A live attenuate vaccine been used in US since 1963
Administered to children as part of MMR (2-5% dont respond to first dose)
Most states require first dose at 1-2 yrs and then second before starting school

Question 11

Rubella is what

Answer 11

relatively benign infection in children
arthritis and arthralgia in adults
congenital infection can result in cataracts, mental retardation, and deafness

Question 12

Rubella vaccination

Answer 12

has reduced number of cases in US by 99%

Question 13

Rubella - transmission

Answer 13

respiratory

replication in nasopharyx and regional lymph nodes

Question 14

Rubella - viremia

Answer 14

viremia 5-7 days after exposure with spread to tissues

placenta and fetus infected during viremia

Question 15

Rubella - immune complexes

Answer 15

rash and arthralgia are the result of immune complexes associated with the infection

Question 16

Rubella clinical features

Answer 16

incubation 2-3 weeks
prodrome of low grade fever
maculopapular rash appears 14-17 days after exposure
Progresses from head to foot!
Is fainter than measles rash, does not coalesce

Question 17

Epidemic rubella - US

Answer 17

1964-1965

12.5 million rubella cases

Question 18

Rubella -workers exposed to rubella virus who do not have documented immunity need to

Answer 18

be excluded from duty until 21 days after last exposure

Question 19

Mumps are what

Answer 19

same family as measles virus

Prior to routine vaccination (1960s) - 150-200,000 cases annually! now typically less than 1000

Question 20

Mumps - outbreaks

Answer 20

large and small outbreaks still tend to occur

Cases peak in later winter and early spring - commonly acquired at school, secondary spread to family members

Question 21

Mumps - acquired by what

Answer 21

transfer or respiratory droplets

virus replicates in the nasopharynx and regional lymph nodes (1-3 wks)

Question 22

Mumps - a primary viremia spreads the virus to

Answer 22

multiple tissues including salivary glands, testes, ovaries, and meninges
inflammation of the infected tissues leads to the characteristic clinical symptoms of parotitis, orchitis, oophoritis, and meningitis

Question 23

Mumps - clinical disease

Answer 23

short, non specific prodrome (myalgia, malaise, fever)
50% develop salivary gland swelling and pain (parotitis)
Virus shed from 3 days before to 4 days after onset of active disease

Question 24

Mumps - complications - CNA involvement

Answer 24

15-50% show signs of meningitis or encephalitis

Question 25

Mumps - complications - orchitis

Answer 25

testicular inflammation most common complication in postpubertal males 20-50% of males mostly unilateral develops within 4-10 days of onset of parotitis following resoluation, can have atrophy (sterility is rare though)

Question 26

Mumps - complications - oophoritis

Answer 26

ovarian inflammation occurs in 5% of postpubertal females no evidence that it impacts fertility

Question 27

Mumps - complications - deafness

Answer 27

1/20,000 infected individuals typically unilateral results from direct damage to cochlea by virus may be transient or permanent

Question 28

Mumps - diagnosis

Answer 28

clinical manifestations - parotitis

Question 29

Mumps - tx

Answer 29

symptomatic relief

Question 30

Mumps - prevention/control

Answer 30

Vaccination - first dose is typically given at 1 yr in cobined MMR and second dose at 4-6 yrs

Question 31

Mumps - prevention/control - workers exposed to mumps virus who do not have documented immunity be

Answer 31

excluded from duty until 26 days after last exposure

Question 32

Pink eye - acute conjunctivitis/pharyngoconjunctivitis - most common cause is

Answer 32

adenovirus | measles and rubella can cause it too though

Question 33

Pink eye is spread through

Answer 33

respiratory droplets or contaminated surfaces

Question 34

Pink eye infections usually occur in

Answer 34

winter and summer

Question 35

Epidemic keratoconjunctivitis

Answer 35

adult pink eye corneal and conjunctival infection inflammaion can cause coreal opacity pain, photophobia and blurre vision are common

Question 36

epidemic keratoconjunctivitis - virus shed for

Answer 36

1-2 weeks after resolution of symptoms

Question 37

Pink eye (children) and epidemic keratoconjunctivitis (adults) are caused by

Answer 37

different adenovirus types

Question 38

Pink eye - incubation period

Answer 38

3-14 days prior to the onset of symptoms pain, foreign body sensation, photophobia may accompany tearing virus shed for 7-10 days after onset of sx self-limited with resolution in 7-10 days infection can be uni or bilateral

Question 39

Pink eye prevention - workers

Answer 39

working should be excluded from patient care during duration of illness