Virus CIS

Question 1

50yo F one day fever, weakness, aches, hurts all over, T 102, WBC 5,900 1% bands

Answer 1

nasal swab influenza A

Question 2

most appropriate initial therapy for influenza

Answer 2

oseltamivir

Question 3

neurominidase inhibitor

Answer 3

oseltamivir

zanamivir

Question 4

mechanism of oseltamivir

Answer 4

neuroanimidase inhibitor

• influenza A and B
• blocks release of virions

Question 5

active against influenza A and B

Answer 5

oseltamivir

Question 6

block release of influenza A only

Answer 6

rimantadine and amantadine

prevents penetration of influenza A - block uncoating of virus

Question 7

benefit of beginning antiviral tx

Answer 7

prevent viral shedding

• within 48 hours
• decrease duration of symptoms 1 - 2 days

Question 8

used with contraindication in asthma/COPD patient

Answer 8

zanamivir

-bronchospasm, decreased pulmonary function

Question 9

side effect of oseltamivir

Answer 9

diarrhea, nausea, vomiting

Question 10

3mo infant, fever, difficulty feeding, nasal discharge, stop breathing when feeding, premature birth and congenital heart disease

Answer 10

respiratory syncytial virus

Question 11

RSV

Answer 11

age < 12 mo
winter season
lower resp tract

Question 12

Tx of RSV

Answer 12

primarily supportive

and possibly bronchodilators - if wheezing

Question 13

ribavirin

Answer 13

inhalation aerosol

nucleoside analog - inhibit RNA and DNA virus replication, inhibit viral protein synthesis

toxic to healthcare workers

only for life-threatening disease

Question 14

palivizumab

Answer 14

monoclonal Ab

-prophylaxis for RSV given monthly

Question 15

52yo M kidney transplant follow up, DMII, elevated serum Cr (normal with kidney transplant)

Answer 15

trimethoprim/sulfamethoxazole (bactrim) - prophylaxis for PCP

pneumocystic jirovecii

immunocompromised patient

Question 16

TMP-SMX

Answer 16

trimethoprim/sulfamethoxazole - prophylaxis for PCP

Question 17

alternative for sulfa given bactrim

Answer 17

atovaquone
dapsone
inhaled pentamidine

Question 18

valganciclovir

Answer 18

prophylaxis for CMV

Question 19

CMV prophylaxis

Answer 19

valganciclovir

Question 20

CMV

Answer 20

most common following solid organ transplant

1-4 months after transplant

highest risk if donor + for CMV in negative recipient

Question 21

34yo M painful rash on left back and chest, pain, burning, tingling

Answer 21

varicella zoster

Question 22

varicella zoster

Answer 22

respiratory droplets

human mucosa and nerves

infected when child with chicken pox

remains dormant in CN ganglia - dorsal ganglia

reactivation - herpes zoster

Question 23

Tx of varicella zoster

Answer 23

acyclovir

oral - shingles
IV - if immunocompromised

Question 24

varicella zoster vaccine

Answer 24

adults > 60yo
live attenuated

not in immunocompromised
-AIDS, HIV, CD4 < 200, anti-tumor necrosis factor

Question 25

virus specific acyclovir

Answer 25

requires viral specific thymidine kinase activation step inhibits DNA synthesis

Question 26

limitation of acyclovir

Answer 26

low bioavailability valacyclovir - higher bioavailability - absorbed better

Question 27

varicella zoster tx

Answer 27

onset of rash - within 72 hours moderate reduction in postherpetic neuralgia

Question 28

9yo M, ER, fever, cough, difficulty breathing, rash started on face and spread downward, T 104, pulse 140, throat small red spots with blue - white centers, blotchy red rash over body, CXR infiltrate

Answer 28

koplik spots measles

Question 29

koplik spots

Answer 29

blue white centers small red dots - in throat seen with measles

Question 30

rubeola virus

Answer 30

measle paramyxovirus

Question 31

spread of rubeola virus

Answer 31

resp droplets

Question 32

3 C of rubeola

Answer 32

measles cough, coryza, conjunctivitis

Question 33

how long measles infectious

Answer 33

4 days prior to rash until 4 days after onset of rash

Question 34

complications of measles

Answer 34

diarrhea, otitis media, pneumonia postinfection encephalomyelitis subacute sclerosing panencephalitis (severe) - years after measles - fatal

Question 35

measles prevention

Answer 35

MMR vaccine

Question 36

16yo M, fever, HA, malaise, facial swelling 3 days, pain in testicles, swollen/tender

Answer 36

mumps parotitis aseptic meningitis orchitis

Question 37

mumps transmission

Answer 37

droplet spread - upper resp secretions

Question 38

55yo M nurse, fever, chills, myalgia, HA, T 100, Sx progress weakness, HA, confusion, SOB, N/V/D, rash, petichiae on legs, liver enzymes elevated, prolonged PT and PTT, fibrin degradation products, multiorgan failure, death

Answer 38

DIC - long PT, PTT, fibrin degradation products ebola

Question 39

ebola

Answer 39

single-strand RNA virus -hemorrhagic fever virus coag defect, cap leak syndrome, shock begins non-specific flu sx tx - supportive -experimental - ZMapp - monoclonal Abs for ebola viral glycoprotein

Question 40

4yo M dyspnea, fever, runny nose, sneezy, cough body aches, severe SOB last couple days, hypoxic, expiratory wheezing, CXR b/l interstitial infiltrates, tx goes home, 2 weeks later flaccid paralysis of lower extremities

Answer 40

DDx - polio, guillane barre, botulism anterior myelitis on MRI - polio enterovirus D68

Question 41

SARS

Answer 41

coronarvirus -birds, small mammals fever, flu, dry cough, dyspnea, far east or toronto mortality 50%