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Questions and Answers

A patient presents with gingivostomatitis, characterized by vesicular lesions on the gums and lips. Which virus is most likely responsible for these findings?

  • Epstein-Barr virus (EBV)
  • Herpes simplex virus type 1 (HSV-1) (correct)
  • Human herpesvirus 6 (HHV-6)
  • Varicella-zoster virus (VZV)

A patient with suspected viral encephalitis undergoes a lumbar puncture. Which of the following cerebrospinal fluid (CSF) findings is most indicative of HSV encephalitis?

  • Increased opening pressure, increased protein, and normal glucose (correct)
  • Normal opening pressure, normal protein, and decreased glucose
  • Decreased opening pressure, decreased protein, and increased glucose
  • Decreased opening pressure, increased protein, and decreased glucose

Which of the following mechanisms of action (MOA) describes how acyclovir is effective in treating HSV encephalitis?

  • Blocking viral attachment to host cells
  • Inhibiting viral DNA polymerase (correct)
  • Inhibiting viral reverse transcriptase
  • Disrupting the viral protein coat

A patient is diagnosed with infectious mononucleosis (mono) caused by the Epstein-Barr virus (EBV). Which cellular receptor does EBV primarily target for attachment and entry into host cells?

<p>CD21 (B-cells) (A)</p> Signup and view all the answers

A patient presents with symptoms suggestive of Epstein-Barr virus (EBV) infection. A Monospot test is performed. What immunological principle underlies the Monospot test's ability to detect EBV infection?

<p>Detection of heterophile antibodies that agglutinate with animal erythrocytes (C)</p> Signup and view all the answers

A patient presents with unilateral vesicles on a specific dermatome that does not cross the midline. Which of the following viruses is most likely responsible for this presentation?

<p>Varicella-Zoster Virus (VZV) (B)</p> Signup and view all the answers

A child presents with several days of high fever followed by a macular eruption. Which of the following viruses is the most likely cause?

<p>Human Herpesvirus 6 (HHV-6) (C)</p> Signup and view all the answers

An immunocompromised patient, positive for HIV, presents with violaceous, raised cutaneous plaques. Which of the following viruses is most likely associated with this patient's condition?

<p>Human Herpesvirus 8 (HHV-8) (D)</p> Signup and view all the answers

A child presents with a 'slapped-cheek' appearance and a lace-like reticular rash on the trunk. Which virus is the most likely cause of this presentation?

<p>Parvovirus B19 (B)</p> Signup and view all the answers

A patient with sickle cell disease experiences a sudden drop in red blood cells (RBCs), indicating an aplastic crisis. Which virus is most commonly associated with causing aplastic crisis in these patients?

<p>Parvovirus B19 (C)</p> Signup and view all the answers

A child presents with profuse, watery diarrhea. Which of the following viruses is the most likely causative agent?

<p>Rotavirus (A)</p> Signup and view all the answers

A child presents with a rash that initially appeared on the face and then spread to the trunk, arms, and legs, sparing the palms and soles. Which vitamin is known to reduce the morbidity associated with this infection?

<p>Vitamin A (D)</p> Signup and view all the answers

An unvaccinated child develops ataxia, myoclonus, vision defects, and changes in behavior years after a measles infection. Which complication of measles is most likely?

<p>Subacute sclerosing panencephalitis (SSPE) (A)</p> Signup and view all the answers

A newborn presents with oral thrush, interstitial pneumonia, and severe lymphopenia. The infant's mother is HIV-positive and used intravenous drugs during pregnancy. What is the most likely route of transmission of HIV to the infant?

<p>Vertical transmission during pregnancy or delivery (A)</p> Signup and view all the answers

A patient with HIV develops Pneumocystis jirovecii pneumonia. At what CD4+ T-cell count is this opportunistic infection most likely to occur?

<p>CD4+ count &lt; 200 cells/μL (A)</p> Signup and view all the answers

A patient with AIDS presents with memory loss, imbalance, clumsiness, and difficulty finding words. A biopsy reveals microglial nodules with multinucleated giant cells. What is the most likely diagnosis?

<p>HIV Encephalopathy (C)</p> Signup and view all the answers

A patient presents with oral ulcers and a rash on the palms and soles. Which of the following viruses is the most likely causative agent?

<p>Enterovirus (C)</p> Signup and view all the answers

A patient presents with fever, polyarthritis, lymphopenia, and a history of recent travel to Puerto Rico. Which of the following viruses is the most likely cause?

<p>Chikungunya Virus (A)</p> Signup and view all the answers

A patient who recently underwent a solid organ transplant presents with pneumonitis. Histological examination of a transbronchial biopsy reveals cells with inclusions. Which virus is most likely the cause?

<p>Cytomegalovirus (CMV) (D)</p> Signup and view all the answers

Which of the following mechanisms of action describes how amphotericin B works to treat fungal infections?

<p>Binds to ergosterol and alters cell membrane permeability (C)</p> Signup and view all the answers

A 30-year-old patient presents with intense pruritus in the genital area and admits to multiple sexual partners. Upon examination, small insects are noted attached to the pubic hair. Which of the following treatments is most appropriate?

<p>Topical permethrin (B)</p> Signup and view all the answers

A patient from Central America presents with new-onset seizures. Brain imaging reveals multiple ring-enhancing lesions with calcifications. Which of the following is the most likely causative agent?

<p>Taenia solium (D)</p> Signup and view all the answers

A patient diagnosed with malaria is prescribed chloroquine. What is the mechanism of action of chloroquine in treating malaria?

<p>Eliminating susceptible erythrocytic forms of Plasmodium species (B)</p> Signup and view all the answers

A patient with malaria is prescribed primaquine. What is the purpose of using primaquine in the context of malaria treatment?

<p>Preventing relapses in Plasmodium vivax and Plasmodium ovale infections (B)</p> Signup and view all the answers

A patient with malaria is treated with chloroquine but remains symptomatic. Further testing reveals the presence of Plasmodium vivax. Why might chloroquine not have been effective in this case?

<p>Chloroquine does not affect the exoerythrocytic liver stage of <em>P. vivax</em>. (B)</p> Signup and view all the answers

A blood smear from a patient with malaria shows that red blood cells of all ages are infected. This finding is most characteristic of which Plasmodium species?

<p>Plasmodium falciparum (D)</p> Signup and view all the answers

A patient develops neutropenia following chemotherapy treatment. What is the most common cause of neutropenia in this context?

<p>Bacterial flora due to damage across mucosal sites (C)</p> Signup and view all the answers

A patient in the hospital develops a bloodstream infection after insertion of an intravascular catheter. Which of the following organisms is most commonly associated with this type of infection?

<p>Staphylococcus aureus (C)</p> Signup and view all the answers

A patient presents with a painful genital ulcer. Gram stain is negative for typical organisms. Which of the following is the most likely causative agent?

<p>Haemophilus ducreyi (B)</p> Signup and view all the answers

A patient presents with genital warts and is diagnosed with condyloma acuminatum. Which of the following best describes these lesions?

<p>Non-ulcerative lesions (A)</p> Signup and view all the answers

A researcher is studying the mechanism of action of maraviroc. Which of the following cellular processes is directly inhibited by this drug?

<p>Binding of HIV to the CCR5 receptor on macrophages. (A)</p> Signup and view all the answers

A patient with a confirmed HIV diagnosis develops resistance to protease inhibitors. Which is the most likely underlying mechanism contributing to this resistance?

<p>Mutations in the viral pol gene, leading to altered protein processing. (A)</p> Signup and view all the answers

West Nile Virus is transmitted to humans through the bite of an infected mosquito. Prior to infecting humans, where does the virus typically replicate?

<p>Within bird populations. (D)</p> Signup and view all the answers

A patient presents with fever, paralysis, and a history of recent contact with bats. Which of the following viruses should be most suspected?

<p>Rabies Virus. (A)</p> Signup and view all the answers

Which of the following is the function of hemagglutinin in the influenza virus?

<p>Promotion of viral entry into host cells. (C)</p> Signup and view all the answers

A neonate is diagnosed with Cytomegalovirus (CMV) following the presentation of jaundice, hepatomegaly, and intracranial calcifications. Which type of infection is most commonly associated with this presentation?

<p>TORCH infection. (A)</p> Signup and view all the answers

What is the mechanism of action of azole antifungals?

<p>Blockage of ergosterol synthesis through inhibition of lanosterol 14-alpha-demethylase. (A)</p> Signup and view all the answers

A lung biopsy from a patient with suspected fungal infection demonstrates large, round yeasts with doubly refractile walls and single broad-based buds.. Which fungal infection is most likely?

<p>Blastomyces dermatitidis. (C)</p> Signup and view all the answers

A patient who is being treated with amphotericin B for mucormycosis begins to experience muscle weakness and cardiac arrhythmias. Which of the side effects listed below would be most likely responsible for these manifestations?

<p>Severe hypokalemia. (A)</p> Signup and view all the answers

A gardener develops a lesion on their hand after being pricked by a rose thorn. Over the next few weeks, more papules develop, moving proximally up their arm. Which is a likely causative agent?

<p>Sporothrix schenckii. (C)</p> Signup and view all the answers

Flashcards

HSV-1 Presentation

Gingivostomatitis (vesicular lesions on gums and lips).

HSV Encephalitis Presentation

Confusion, increased lumbar puncture opening pressure/protein, normal glucose.

Acyclovir MOA

Inhibit Viral DNA Polymerase.

Epstein-Barr virus (EBV)

Herpesvirus causing acute infectious mononucleosis (kissing disease).

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EBV Attachment

CD21 (B-cells), causing proliferation and heterophile antibody production.

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EBV Associated Disease

Nasopharyngeal carcinoma (especially in Chinese populations).

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Monospot test

Tests for heterophile antibodies associated with EBV infection.

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Varicella-zoster Presentation

Primary has fever, macules, then pustules/vesicles. Secondary are unilateral vesicles on a dermatome.

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HHV-8 Presentation

Violaceous raised cutaneous plaques commonly seen in immunocompromised patients.

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Parvovirus B19 Presentation

Erythema infectiosum, slapped-cheek and lace, reticular truncal rash can cause aplastic crisis.

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Rotavirus Presentation

Profuse, watery diarrhea in children.

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Measles Presentation

Rash starts on face, then spreads to trunk/legs (sparing palms/soles).

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HIV Congenital Presentation

Oral thrush, interstitial pneumonia, severe lymphopenia.

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Antiretroviral therapy (ART)

Inhibits viral enzyme to stop replication.

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HIV Encephalopathy Presentation

Patient has memory loss, imbalance, clumsiness, and difficulty finding words.

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Variola Virus Presentation

Vesiculopustular rash with lesions at same stage of development.

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Enterovirus Presentation

Oral ulcers, with rashes on palms/soles.

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Rabies Virus Presentation

Spasms, paralysis and has been around bats.

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Cytomegalovirus (CMV)

Jaundice, hepatomegaly, rash, intracranial calcifications.

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Sporothrix schenckii Presentation

Skin lesions on hand that travel proximally up the arm.

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Pubic Lice

Parasite is Pthirus pubis causing intense itching in the genital area, often associated with multiple sex partners.

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Neurocysticercosis

Infection caused by Taenia solium (pork tapeworm), presenting with new seizures, brain calcifications, and is often seen in patients with an immigration history.

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Chloroquine, Artemisinin or Atovaquone-proguanil

Eliminate susceptible erythrocytic forms of all Plasmodium species.

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Primaquine

Prevents relapses seen with Plasmodium vivax and Plasmodium ovale infections because these species have an exoerythrocytic liver stage (hypnozoite) that chloroquine does not affect.

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Neutropenia

Low number of neutrophils in the blood, increasing the risk of infection.

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Chemotherapy-induced neutropenia Cause

Most often caused by bacterial flora due to damage across mucosal sites during chemotherapy.

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Catheter Related Bloodstream infections

Nosocomial bloodstream infections stemming from intravascular catheters can be associated with staphylococcus aureus and staphylococcus epidermidis.

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Chancroid

A painful ulcer typically caused by Haemophilus ducreyi.

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Condyloma accuminatum

Genital warts are NOT painful ulcers.

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Adenovirus Presentation

Self-limited upper respiratory infection, or gastroenteritis.

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HIV integrase

Specifically targets integrase, preventing the production of viral mRNA.

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HIV antiretroviral resistance

Mutations in the pol gene, often due to inconsistent therapy.

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HIV Cell Attachment Involves

Bind to CD4 (T cells).

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CCR5 treatment

Maraviroc

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HPV cause

Oropharyngeal carcinomas (HPV-16 & HPV-18)

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Influenza virus virology

Negative sense, single stranded RNA virus.

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Azoles MOA

Blocks fungal enzyme lanosterol 14-alpha-demethylase, which converts lanosterol to ergosterol.

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Echinocandins MOA

Inhibit synthesis of glucan, a component of the cell wall.

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Allylamines MOA

Inhibition of squalene epoxidase, which inhibits synthesis of ergosterol.

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Study Notes

  • The existing study notes have been updated with the information in the provided text

Lice (Pubic)

  • Phthirus pubis is the parasite responsible for pubic lice
  • Intense pruritus in the genital area, especially with multiple sex partners, is a key sign
  • Topical permethrin serves as the treatment

Neurocysticercosis

  • Taenia solium (pork tapeworm) is the pathogen
  • New seizures, brain calcifications, and a history of immigration are indicative
  • Brain imaging shows calcifications

Malaria

  • Plasmodium species is the pathogen
  • Chloroquine, Artemisinin or Atovaquone-proguanil eliminate susceptible erythrocytic forms of all Plasmodium species
  • Primaquine prevents relapses for Plasmodium vivax and Plasmodium ovale infections
  • Plasmodium vivax and ovale have an exoerythrocytic liver stage (hypnozoite) unaffected by chloroquine
  • Blood smear can detect malaria

Plasmodium falciparum

  • Has the ability to infect RBCs of all ages, increasing its parasitemia compared to other plasmodium species

Febrile Neutropenia

  • Neutropenia involves a low number of neutrophils in the blood

Chemotherapy-Induced Neutropenia

  • It is caused most often by bacterial flora due to damage across mucosal sites
  • Nosocomial bloodstream infections usually stem from intravascular catheters
  • They are associated with staphylococcus aureus and staphylococcus epidermidis

Chancroid

  • Painful ulcers characterize it
  • Haemophilus ducreyi is the cause

Condyloma Accuminatum

  • Genital warts are present
  • There is no ulceration observed

Adenovirus

  • Results in self-limited upper respiratory infection, or gastroenteritis
  • It's a double-stranded, non-enveloped DNA virus

HIV

  • Integrase will inhibit production of viral mRNA
  • Mutations in the pol gene happens with the HIV strain and it transcribes many enzymes attached by antiretroviral therapy
  • Antiretroviral resistance mainly appears due to inconsistent antiretroviral therapy
  • Cell attachment impacts CD4 (T cells)
  • Protease inhibitors such as ritonavir/lopinavir are treatments
  • Mutations in protein processing leads to resistance to Protease inhibitors
  • Using NRTIs and NRTIS are effective in treating this
  • HIV can use CCR5 or CXCR4 receptors to enter cells such as helper T cells and macrophages
  • CCR5 allows for HIV to enter macrophages more
  • Maraviroc is a treatment option for CCR5 which inhibits CCR5; therefore, it will not treat CXCR4 strains
  • CXCR4 allows for HIV to enter T lymphocytes more

Variola Virus

  • Results in smallpox
  • Vesiculopustular rash with lesions at the same stage of development

West Nile Virus

  • Fever with neuroinvasive symptoms, extremity weakness, confusion, and flaccid paralysis are indicative of this virus
  • This is found more in the summer months
  • Mosquito bites transmit this
  • The virus replicates in birds and is then uptaken by mosquitoes feeding on the birds
  • Mosquitoes bite humans and infect them after feeding on birds, there are multiple dead birds in the area

Human Papilloma Virus (HPV)

  • Oropharyngeal carcinomas are caused by HPV-16 and HPV-18

Rabies Virus

  • Spasms, paralysis and exposure to bats are indicative
  • Inactivated vaccine can be used as prophylaxis

Influenza Virus

  • Negative sense, single stranded RNA virus
  • Hemagglutinin promotes progeny viral entry and lets the virus in
  • Neuraminidase promotes progeny viral release and sends the virus away

Cytomegalovirus (CMV)

  • Jaundice, hepatomegaly, rash and intracranial calcifications are indicative of neonatal presentation
  • TORCH infection can be seen
  • Mothers may have a febrile illness that they recovered from

Candida Infection

  • Azoles block the fungal enzyme lanosterol 14-alpha-demethylase a CYP450-dependent enzyme that converts lanosterol to ergosterol

Echinocandins

  • Caspofungin and micafungin inhibit the synthesis of glucan, a component of the cell wall

Pyrimidines

  • Flucytosine converts to 5-fluorouracil in the fungal cell and interferes with RNA and protein synthesis

Allylamines

  • Terbinafine inhibits squalene epoxidase, which inhibits the synthesis of ergosterol
  • Tinea Corporis uses allylamines

Mucormycosis

  • Amphotericin B is the treatment
  • Side effects consists of severe hypokalemia and hypomagnesemia

Blastomyces dermatitidis

  • Great Lakes region, and Ohio and Mississippi River Valleys have this fungus
  • This fungus is found in soil
  • Pneumonia can be seen
  • Large, round yeasts with doubly refractile wall and single broad-based bud exists and can be found with biopsy

Cryptococcus neoformans

  • India ink (or mucicarmine) stain detects Cryptococcus neoformans
  • Budding yeast forms with thick capsules

Aspergillus fumigatus

  • Fungi that infects HIV patients (<50 CD4) and worsens asthma (allergic bronchopulmonary aspergillosis)

Histoplasmosis capsulatum

  • Tiny intracellular yeast forms and tuberculate macroconidia grown at room temperature can be found in smears
  • Transmission impacts inhalation of spores that are found in bird or bat droppings

Sporothrix schenckii

  • Skin lesions on hand that travel proximally up the arm are indicative of this dimorphic fungus
  • Elongated yeast cells with narrow-based buds can be found with microscopy, it exists as yeast at room temperature
  • This exists due to contact with soil and plant materials

Sporotrichosis

  • Trauma allows it to get into the skin where it's more common in soil
  • Site of initial trauma results in a papule, following by smaller papules moving proximal up the extremity

Coccidioides immitis

  • Fungus endemic to central valley of California
  • Self-limited respiratory illness
  • Large spherules containing endospores can be found with microscopy

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