Viruses

Question 1

HSV common sites
A. HSV 1
B. HSV 2

Answer 1

A. Trigeminal ganglia
B. Sacral nerve root ganglia (S2-S5)

Question 2

frequency of reactivation of infection is influenced by anatomic site and virus type
A. HSV 2
B. HSV 1

Answer 2

A. Genital hsv
B. Oral-labial hsv

Question 3

most common clinical manifestations of first-episode HSV-1 infection

Answer 3

Gingivostomatitis and pharyngitis

Question 4

most common clinical manifestation of reactivation HSV-1 infection

Answer 4

Recurrent herpes labialis

Question 5

HSV infection of the finger

Answer 5

Herpetic whitlow

Question 6

presents as an acute onset of pain, blurred vision, chemosis, conjunctivitis, and characteristic dendritic lesions of the cornea

Answer 6

HSV keratitis

Question 7

the gold standard for defining HSV encephalitis

Answer 7

Brain biopsy (replaced by PCR for HSV DNA in CSF)

Question 8

Treatment of HSV encephalitis

Answer 8

IV acyclovir (30 mg/kg per day in three divided doses for 14–21 days

Question 9

HSV is the most commonly identified cause of recurrent lymphocytic meningitis (also called)

Answer 9

Mollaret’s meningitis

Question 10

There is increasing experimental evidence suggesting an association between herpesvirus pathogens, specifically HSV-1, and the development of ______

Answer 10

sporadic Alzheimer’s disease (AD)

Question 11

In previously seronegative women, risk of mother-to-child transmission of HSV in the perinatal period is highest when the infection is acquired

Answer 11

near the time of labor

Question 12

when women are seropositive for HSV-2 at the outset of pregnancy, what is the effect on neonate?

Answer 12

no effect on neonatal outcomes (including birth weight and gestational age) is seen

Question 13

Deliveryof pregnant women with recurrent genital herpes

Answer 13

Women who have no evidence of lesions can have a vaginal delivery. The presence of active lesions on the cervix or external genitalia is an indication for cesarean delivery

Question 14

When can a clinical diagnosis of HSV be accurately made?

Answer 14

characteristic multiple vesicular lesions on an erythematous base are present

Question 15

the most sensitive laboratory technique for detecting mucosal or visceral HSV infections and is the recommended test for laboratory confirmation of a diagnosis

Answer 15

HSV DNA detection by PCR

Question 16

Wha drug has been shown to reduce transmission of HSV-2 between sexual partners..?

Answer 16

Valacylovir 500mg OD

Question 17

Patient with varicella is infectious

Answer 17

~48 h before the onset of the vesicular rash, during the period of vesicle formation (which generally lasts 4–5 days), and until all vesicles are crusted

Question 18

The skin lesions—the hallmark of the infection of chickenpox

Answer 18

maculopapules, vesicles, and scabs in various stages of evolution

Question 19

most common infectious complication of varicella is

Answer 19

secondary bacterial superinfection of the skin

Question 20

The most common extracutaneous site of involvement in children is

Answer 20

CNS

Question 21

The most serious complication following chickenpox

Answer 21

Varicella pneumonia

Question 22

sporadic disease that results from reactivation of latent VZV from dorsal root ganglia

Answer 22

Herpes zoster (shingles)

Question 23

Most frequent dermatome involved in herpes zoster

Answer 23

dermatomes from T3 to L3

Question 24

The most serious complication following chickenpox

Answer 24

Varicella pneumonia

Question 25

True or false Patients with herpes zoster can transmit infection to seronegative individuals, resulting in chickenpox

Answer 25

True

Question 26

pain and vesicles appear in the external auditory canal, and patients lose their sense of taste in the anterior two-thirds of the tongue while developing ipsilateral facial palsy

Answer 26

Ramsay Hunt syndrome

Question 27

HPV type A. Genital warts B. Dysplastic lesions (cervical Ca)

Answer 27

A. HPV 6 and 11 B. HPV 16 and 18

Question 28

Reactive airways causing wheezing are most often due to constriction of lumen size at the level of the _____

Answer 28

bronchioles (which have the narrowest lumen diameter of the airways

Question 29

is the principal risk factor for severe illness from COVID-19

Answer 29

Advanced age

Question 30

Janus kinase inhibitor to be used only in combination with remdesivir in COVID-19 patients requiring oxygen or mechanical ventilation

Answer 30

baricitinib

Question 31

now approved for hospitalized children ≥12 years and adults with COVID-19 with any level of severity, Its efficacy may be highest in those with mild to moderate disease

Answer 31

Remdesivir

Question 32

IL-6 receptor antagonist; experts suggest adding to dexamethasone therapy in patients with severe or progressive COVID-19

Answer 32

tocilizumab

Question 33

Among influenza A viruses, phenomenon that enables them to react to the prevailing immunity in the community by modifying their immunogenic epitopes, particularly on the hemagglutinin surface protein

Answer 33

Antigenic drift

Question 34

Due to the the segmentation of their genomes, which allows genes coding both surface and internal proteins to be reassorted between influenza A variants

Answer 34

Antigenic shift

Question 35

pathognomonic of measles and consist of bluish white dots ~1 mm in diameter surrounded by erythema; appear first on the buccal mucosa opposite the lower molars; fades with onset of rash

Answer 35

Koplik spots

Question 36

The CDC case definition for measles (rubeola) requires

Answer 36

(1) a generalized maculopapular rash of at least 3 days’ duration; (2) fever of at least 38.3°C (101°F); and (3) cough, coryza, or conjunctivitis

Question 37

The classic triad of CRS—

Answer 37

clinical manifestations of cataracts, hearing impairment, and heart defects

Question 38

The most characteristic pathologic finding in rabies; are eosinophilic cytoplasmic inclusions in brain neurons that are composed of rabies virus proteins and viral RNA

Answer 38

Negri bodies

Question 39

The major difference between the genomes of HIV-1 and HIV-2 is the fact that

Answer 39

HIV-2 lacks the vpu gene and has a vpx gene not contained in HIV-1

Question 40

By far the most common mode of HIV infection, particularly in developing countries, is

Answer 40

heterosexual transmission

Question 41

Highest per-act risk for HIV transmission

Answer 41

Parenteral: blood transfusion Sexual: receptive anal (Anal > penile-vaginal > oral sex and receptive > insertive)

Question 42

Higher rates of transmission have been reported to be associated with many factors— the best documented of which is the

Answer 42

presence of high maternal levels of plasma viremia, with the risk increasing linearly with the level of maternal plasma viremia. very unlikely that mother-to-child transmission will occur if the mother’s level of plasma viremia is <1000 copies of HIV RNA/mL of blood and extremely unlikely if the level is <50 copies/mL

Question 43

Higher rates of transmission

Answer 43

- high maternal levels of plasma viremia -higher HLA match -prolonged interval between membrane and delivery

Question 44

risk factors for mother-to-child transmission of HIV via breast-feeding include

Answer 44

detectable levels of HIV in breast milk, the presence of mastitis, low maternal CD4+ T-cell counts, and maternal vitamin A deficiency

Question 45

CDC case definition of stage 3 (AIDS) includes

Answer 45

all HIV-infected individuals >5 years of age with CD4+ T-cell counts below 200/ul

Question 46

infected with HIV for a long period (≥10 years), their CD4+ T-cell counts were in the normal range, their plasma viremia remained relatively low (undetectable to several thousand copies of HIV RNA/ml plasma), and they remained clinically stable over years without receiving ART

Answer 46

Long-term nonprogressors

Question 47

where the earliest burst of virus replication occurs associated with marked depletion of CD4+ T cells

Answer 47

GALT

Question 48

is the most common opportunistic infection in HIV-infected individuals

Answer 48

Mycobacterium tuberculosis

Question 49

allele is associated with a slower HIV disease course, possession of this allele is associated with a higher risk of abacavir-associated hypersensitivity

Answer 49

HLAB*57:01

Question 50

Virus implicated in Kaposi sarcoma in HIV patients

Answer 50

HHV 8

Question 51

greatest use as a screening test for HIV infection in patients suspected of having the acute HIV syndrome

Answer 51

p24 antigen capture assay

Question 52

is the laboratory test generally accepted as the best indicator of the immediate state of immunologic competence of the patient with HIV infection

Answer 52

CD4+ T-cell count

Question 53

Addition of glucocorticoids in PCP

Answer 53

For patients with a Pao2 <70 mmHg or with an a–a gradient >35 mmHg

Question 54

Indications for Prophylaxis for PCP

Answer 54

any HIV-infected individual who has experienced a prior bout of PCP, any patient with a CD4+ T-cell count of <200/4L or a CD4 percentage <15, any patient with unexplained fever for >2 weeks, and any patient with a recent history of oropharyngeal candidiasis

Question 55

HIV white, frondlike lesions, generally along the lateral borders of the tongue and sometimes on the adjacent buccal mucosa. not considered a premalignant condition

Answer 55

Oral hairy leukoplakia

Question 56

ulcerating lesion of the skin due to a necrotizing vasculitis; unexplained fever; nephrotic syndrome; and neurosyphilis

Answer 56

Lues maligna

Question 57

The most common presentation of syphilis in the HIV infected patient is

Answer 57

Condylomata lata

Question 58

The one autoimmune disease that may occur with an increased frequency in patients with HIV infection is

Answer 58

a variant of primary Sjögren’s syndrome

Question 59

the etiologic agent of progressive multifocal leukoencephalopathy (PML)

Answer 59

JC virus

Question 60

The most common peripheral neuropathy in patients with HIV infection is a distal sensory polyneuropathy (DSPN) also referred to as painful sensory neuropathy (HIV-SN

Answer 60

distal sensory polyneuropathy (DSPN) also referred to as painful sensory neuropathy (HIV-SN)

Question 61

Pneumonia vaccination in HIV

Answer 61

Pneumococcal conjugated vaccine (13) 0.5 mL IM % 1 followed in 8 weeks or more by pneumococcal polysaccharide vaccine (23) if CD4+ T-cell count >200

Question 62

This syndrome id associated with pain, keratitis, and iritis. It is often associated with orolabial HSV or trigeminal zoster. Ophthalmologic examination reveals widespread pale gray peripheral lesions; caused by HSV and varicella zoster

Answer 62

acute retinal necrosis syndrome, or progressive outer retinal necrosis (PORN)

Question 63

is a KSHV-associated lymphoproliferative disorder; not a true malignancy. Lymph node biopsies reveal a predominance of interfollicular plasma cells and/or germinal centers with vascularization and an “onion skin” (hyaline vascular) appearance

Answer 63

Multicentric Castleman’s Disease

Question 64

Among HIV discordant couples, no HIV transmission is possible if

Answer 64

partner with HIV had a suppressed viral load (defined as having a viral load of <400 copies of HIV RNA per milliliter

Question 65

Rash of measles usually appear in this order

Answer 65

Behind the ears, neck, hairline > face, trunk and arms > legs and feet

Question 66

What is the gold standard for determining previous dengue exposure?

Answer 66

Plaque Reduction Neutralization Test (PRNT)

Question 67

Dengue diagnostics Fist 3 days Beyond 5 days

Answer 67

NS1 IgM ELISA

Question 68

What is the gold standard for testing of rabies?

Answer 68

Fluorescent antibody testing

Question 69

When do antibodies to HIV usually appear?

Answer 69

within 3–6 weeks and almost invariably within 12 weeks of primary infection First to appear are those directed against gp41