infectious diseases- viral infections

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103 Terms

1
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what is the most common cause of the common cold?

rhinovirus (30-50%)

2
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What are the typical presenting symptoms for the common cold?

sniffles and stuffiness

-sore throat

-face pressure/sneezing

3
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Is a fever commonly seen with the common cold?

only in children

4
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How is a diagnosis for the common cold made?

clinically (can usually tell just by looking at them)

-can do viral respiratory panel in children

5
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What is not effective in treating common cold?

codeine, newer gen antihistamines, intranasal glucocorticoids

6
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What is the treatment for the common cold?

symptomatic management (tylenol,decongestant/antihistamine combo)

7
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What are the four types of influenza, which are most commonly seen?

A,B,C,D

- A & B are most commonly seen

(A mutates more than B)

8
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Which lineages are flu A and B from? Which are only circulated in humans?

A - avian & swine (bird, pig, and human spread)

B- yamatage & victora (only circulates in humans)

9
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What are the main presenting symptoms of someone with the flu (3)?

- abrupt onset of fever (100 to 104)

- nonproductive cough

- body aches/myalgia

10
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What is a common presenting symptoms of children with the flu?

N/V, diarrhea (pukes + poops)

11
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What are common presenting symptoms of older adults with the flu?

may present w/o typical symptoms

- altered mental status

- anorexia

- weakness

- dizziness

12
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In most cases, how long to fever & respiratory symptoms last with the flu? How long does a complete recovery take?

fever + respirtatory sx: last 3 days

complete recovery: by day 14

13
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When would you perform a diagnostic test for the flu?

- immunocompromised pts at risk and super sick pts w acute respiratory symptoms, hospitalized pts w complications or at risk for complications

**testing should only be performed if it will change your medical decision making

14
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What are testing options for the flu? Which is the most accurate?

- rapid antigen detection test (RIDT)

- rapid molecular assays (NAAT) is most accurate

- viral culture, RT-PCR, IFA

15
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What is the treatment for the flu?

-NSAIDs for fever, HA, myalgias

-Tamiflu 75 mg BID x5 days only for sick pts (old/young/hospitalized) either ASAP or within 48 hours

16
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When should oseltamivir (Tamiflu) 75 mg be started in high-risk pts with suspected or confirmed flu diagnosis?

ASAP

(hospitalized pts, severe/complicated illness, 65+, kids <2, pregnancy, HIV, etc)

17
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When should Tamiflu be started for non-high risk pts?

within 48 hours of onset

- helps reduce illness 1-2 days, may help prevent flu complications

18
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What are common side effects of Tamiflu?

N/V, HA, fatigue (flu like symptoms)

19
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Who is the flu vaccine recommended for? Who is it not recommended for?

everyone > 6 months, except for ppl w anaphylaxis rxns to eggs or other flu vaccine + anyone with Guillen Barre

20
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Who received treatment for SARS-CoV-2?

age > 75, immunocompromised, and ppl w multiple med comorbidities (HTN, DM, etc)

21
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What is the treatment for SARS-CoV-2?

-symptoms < 5 days, normal hepatic function: paxlovid

- symptoms > 5 days, otherwise healthy: symptomatic treatment only

22
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What percentage of adults have been infected with EBV? What percent are clinically silent?

90-95% have been infected

- about half are clinically silent

(infection w EBV resides in B lymphocytes for life)

23
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What are some hallmark symptoms of mononucleosis?

- oropharyngeal exudates

- tonsillar enlargement

- palatal petichiae

<p>- oropharyngeal exudates</p><p>- tonsillar enlargement</p><p>- palatal petichiae</p>
24
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What is a rare but potentially life threatening complication of mononucleosis?

splenic rupture (avoid physical contact x 3 weeks)

25
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How is a diagnosis of mononucleosis made?

+ heterophile antibodies (monospot test)

CBC can show > 50% mononuclear cells; 10% atypical lymphocytes

26
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What is the treatment for mononucleosis?

symptomatic tx w NSAIDs/acetaminophen

*avoid strenuous activity for 3x weeks (avoid splenic rupture)

-corticosteroids if airway obstructed (tonsillar enlargement)

27
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If the monospot test is negative for heterophile antibodies, then mononucleosis is most likely caused by _______, not EBV

cytomegalovirus (CMV)

28
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Which cause of infectious mononucleosis usually has milder symtpoms?

CMV

29
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Is splenomegaly seen with CMV mono?

typically no

30
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What are some differences between CMV and EBV infectious mono?

EBV:

-splenomegaly, exudative tonsilitis, cervical + diffuse LAD, teens & young adults, + heterophile antibodies

CMV:

-milder symptoms, children cervical LAD, older adults, rash, negative heterophile antibodies

31
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What are the different cutaneous manifestations of Herpes simplex?

herpetic whitlow and herpetic gladiatorum

32
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What type of herpes manifests as inoculation of finger through break in the skin, and heals similar to oral herpes?

herpetic whitlow

33
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What type of cutaneous herpes manifests on the face, neck, and arms of wrestlers and is often misdiagnosed as bacterial folliculitis or impetigo?

herpetic gladiatorum

34
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What is the lesion in herpetic keratitis seen with a slit lamp and florescein staining?

dendritic lesion

<p>dendritic lesion</p>
35
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What can herpetic keratitis lead to?

retinal necrosis and blepharitis

<p>retinal necrosis and blepharitis</p>
36
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What are severe manifestations of herpes simplex?

- encephalitis

- bells palsy

- aseptic meningitis

- hepatitis

37
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What may occur 24 hours before herpetic lesions appear?

prodrome of pain, burning, tingling, itching

38
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What type of rash is seen with herpes simplex?

vesicular cluster of lesions

- fluid-filled, red or yellow with reddish base

-painful, will break open and eventually crust over

39
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What is the treatment for herpes simplex?

valacyclovir 1000mg BID

acyclovir 400mg TID

start tx within 72 hours, continue for 7-10 days

40
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What is the treatment for a pregnant women w HSV?

acyclovir 400 mg TID

41
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How is HSV transmitted to neonateS?

-utero

-perinatal (most common)

- post natal

HSV -> neonate during labor and delivery from infected site

42
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What are the 3 categories of neonatal herpes simplex perinatal and postnatal infection?

-skin, eye, mouth disease (35-45%)

-CNS disease (33%)

-disseminated disease (25-30%)

43
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What is the treatment for all 3 categories of neonate HSV?

IV acyclovir started ASAP

44
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What is in utero (congenital) herpes and how is it transmitted?

In utero herpes occurs when HSV crosses the placenta during pregnancy, infecting the baby before birth. It is very rare.

45
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What is the most common time for a baby to acquire herpes, and how does it happen?

During labor and delivery (perinatal), by exposure to HSV in the birth canal.

46
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How can a baby get postnatal herpes?

After birth, through close contact with someone who has an active HSV infection, like a cold sore.

47
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Which type of neonatal herpes is the rarest but can cause severe birth defects?

In utero (congenital) herpes

48
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How is CNS disease diagnosed in neonates?

through PCR & CNS studies

49
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What virus is characteristic for a "dew drop on rose petal" appearance?

varicella (chicken pox)

50
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What type of rash appears with varicella?

pruritic vesicles that appear on face and trunk and spread

51
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How long is varicella contagious?

one day before rash appears until lesions have crusted over

52
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What type of virus typically has a dermatomal vesicular rash pattern, prodromal syndrome 103 days before lesions with pain, fever, HA, itching/burning?

varicella zoster (Herpes Zoster)

53
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Does the Herpes Zoster rash cross the midline?

NO

54
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The varicella virus remains dormant in nerve cells, when does the virus get reactivated to cause shingles?

immunosuppression, aging, or illness reactivates virus

55
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What is the treatment for chicken pox?

mostly supportive care (antihistamines, tylenol, topical, trim fingernails)

56
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Who is given antiviral tx with chicken pox?

unvaccinated, > 12, pregnant, or immunocompromised

-acyclovir in pregnancy

-valacyclovir

57
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How is herpes zoster/shingles treated?

-valacyclovir 1000mg po TID for 7 days

- acyclovir 800mg 5x days for 7-10 days

*NSAIDs for adult pain

-may need opiates

58
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If a healthy, vaccinated child has chicken pox, what is the treatment?

no treatment

*avoid aspirin in children (reyes syndrome)

59
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What is the time frame of congenital infections with varicella to occur?

when mother is infected between 8-20 weeks

60
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What occurs with congenital varicella infections ?

-cicatricial skin lesions (dermatomal pattern scars)

-ocular defects (optic nerve atrophy cataract)

- abnormal limbs

-low birth wright

-CNS (seizures, cognitive impairment)

61
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How is congenital varicella treated in a pre-term infant, or birthing parent that had significant infection at time of delivery?

post-exposure prophylaxis with Varizig

IV acyclovir if active infection in newborn (only if they came out w infection)

62
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What tests are used for prenatal diagnosis of congenital varicella syndrome?

PCR testing of fetal blood or amniotic fluid, and ultrasound to detect fetal abnormalities.

63
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What should parents be counseled about if prenatal testing for VZV is positive?

The likely fatal outcome of the disease

64
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What are key components of postnatal diagnosis of congenital varicella syndrome?

Maternal history of VZV infection during 1st or 2nd trimester, fetal abnormalities consistent with the syndrome, and evidence of intrauterine infection.

65
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How is maternal VZV infection managed during pregnancy?

Acyclovir 5 times daily for 7 days and varicella-zoster immune globulin if the mother lacks immunity.

66
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What vaccine is recommended prior to pregnancy for women with no VZV immunity?

Varivax (varicella vaccine).

67
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What is the most common STI globally?

human papilloma virus (HPV)

68
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There are over 200 types of of HPV, which are the high risk types?

16 & 18

69
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Type 16 & 18 of HPV are considered the high risk types and are associated with what percentage of cervical and anal cancers?

- 70% of cervical cancers

- 90% of anal cancers

70
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How does HPV present in men?

penile infection or anal infection (MSM)

- usually genital warts

71
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How does HPV present in women?

anal infection

72
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What are the risks of HPV in women?

- cervical cancer (virtually all cases due to HPV)

- vulvar and vaginal cancer

73
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When does the CDC recommend initial vaccine for HPV?

11-12 years old (can give as early as 9 years)

74
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Which population has a greater prevalence of HPV?

those with HIV

75
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What is the target of attack in HIV?

the immune system, CD4 cells (T cells)

76
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What are the different stages of HIV infection?

-acute HIV w seroconversion

-chronic HIV without AIDS

-chronic HIV w AIDS

77
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What is AIDS defined by?

a CD4 cell count <200 cells/microL

- or the presence of any AIDs defining conditions

78
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What are some examples of AIDS defining conditions?

opportunistic infections

-pneumocystis pneumonia, esophageal candidasis, toxoplasmosis (fungal infections)

-certain malignancies

-wasting or encephalopathy

79
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How often should healthy people (adults and adolescents 13-75) get screened for HIV?

once

80
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Who should always get tested for HIV?

pregnant women

-high risk behaviors

-exposed people/needle stick

81
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What are the testing options for HIV? Which is recommended?

- at home antigen test

and combo antigen/antibody test which is recommended

82
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If initial antigen/antibody test for HIV is negative, what is the assumed result?

negative, person does not have HIV

83
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If initial antigen/antibody test is positive for HIV, what is necessary to confirm the diagnosis?

a confirmatory HIV-1/HIV-2 antibody differentiation immunoassay is performed to confirm the diagnosis

84
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What is the treatment for HIV/AIDS?

Antiretroviral therapy (ART)

85
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What does antiretroviral therapy (ART) do?

supresses serum viral RNA levels and increases CD4 cell counts in the vast majority of pts with acute and early HIV infection

*ART can also reduce the risk to transmission to others

86
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What is important with starting ART therapy for HIV?

start ASAP

- initiate one multidrug regiment

*DO NOT delay treatment while awaiting results of resistance testing

-modify tx as needed once resistance testing results return

87
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What is PEP? Who usually gets treatment and when?

post-exposure prophylaxis

-typically w needle sticks, but can be exposure during sex, sexually assaulted, or exposed at work

**start within 72 hours of exposure -> can prevent HIV development

88
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What happens if PEP is initiated after 72 hours from exposure?

may not prevent HIV if started > 72 hours

89
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What labs are necessary for those getting PEP?

baseline labs (CBC, CMP)

-test at baseline and 2 weeks

then HIV antibody testing: baseline, week 6, week 12 and at 6 months

90
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What is the treatment regimen for post-exposure prophylaxis and what is the time frame?

3 drug regimen, TDF-FTC + dolutegravir

*one pill daily for 28 days

91
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What is PrEP?

pre-exposure prophylaxis for those who are sexually active/or engage in high risk behaviors

*oral therapy with TDF-FTC

92
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How is polio transmitted?

fecal-oral route

(virus may persist in the stool for up to 6 weeks)

93
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What are the different types of polio?

mild illness

severe illness (nonparalytic + paralytic)

94
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What are characteristics of mild polio?

3-6 days incubation

- fever, HA, sore throat, fatigue

symptoms resolve with 1-2 days without sequelae

95
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What are characteristics of nonparalytic polio?

fever, HA, vomiting, meningsmus (meningitis like symptoms)

-CSF pleocytosis

-resolves in 1-2 weeks

- may progress to paralytic

96
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What are characteristic of paralytic polio?

- acute flaccid weakness & pain; asymmetrical

-severe illness

-weakness in one muscle group, but could be quadriplegia and respiratory failure

*legs > arms

*proximal > distal muscles (core weakness)

97
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How is a diagnosis of polio made?

2 stool samples & 2 oropharyngeal swabs 24 hours apart, during first 14 days after limb weakness onset

-CSF analysis

-MRI w contrast of the brain and spine to assess extent of SC inflammation

-NCS/EMG

98
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What is the treatment for polio?

mostly supportive management (pain, PT), mechanical ventilation, cardiac monitoring if bulbar involvement

99
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What is the incubation period for rabies?

1 to 3 months, can be longer

100
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What is the prodrome associate with rabies?

flu like symptoms, often missed