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231 Cards in this Set
- Front
- Back
Medically important helminths
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p194
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Which Cestode (tapeworm) can cause brain cysts and seizures?
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Taenia solium
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Echinococcus granulosus (a cestode) can cause cysts in the ____when ingested in dog feces; and _____ if antigens are released from cysts
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liver, anaphylaxis
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What is the standard treatment for trematodes (flukes)?
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Praziquantel
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Which fluke penetrates human skin, forming granulomas, fibrosis, and inflammation of the spleen & liver?
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Schistosoma
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Larvae of the nematode (roundworm) ___ are known to penetrate skin of feet & cause anemia if infect intestine.
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Ancylostoma duodenale (hookworm)
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Echinococcus granulosus (a cestode) can cause cysts in the ____when ingested in dog feces; and _____ if antigens are released from cysts.
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liver, anaphylaxis
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Which nematode causes anal pruritis?
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Enterobius vermicularis (pinworm)
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Lavae of the nematode ___ are found in the soil, penetrate the skin, and cause intestinal infection.
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Strongyloides stercoralis
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Trichinella spiralis (a nematode) is usually found in what food?
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undercooked meat, usually pork
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Which nematode can be seen crawling in the conjunctiva?
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Loa loa
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Treatment for river blindness, caused by onchocerca volvulus, is ___
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Ivermectin
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Wuchereria bancrofti cause blockage of lymphatic vessels in a condition known as:
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elephantiasis
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Three nematodes treated with Diethylcarbamazine:
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Loa loa, Toxocara canis, and Wucheria bancrofti
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Parasite hints
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p195
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Perianal pruritis caused by:
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Enterobius
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Microcytic anemia a result of infection with
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Ancylostoma, Necator
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Schistosoma mansoni is known to result in
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portal hypertension
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Schistosoma haematobium can cause ___ cancer and hematuria
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bladder
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A trematode that causes hemoptysis is:
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Paragonimus westernani
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Clonorchis sinensis causes disease in the:
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biliary tract
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Virology
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p195
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All DNA viruses are dsDNA except:
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parvoviridae
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All DNA viruses are linear except these two:
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papoviruses, hepadnavirus (circular)
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All RNA viruses are ssRNA except
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Reoviridae ("repeato-virus" (reovirus) is dsRNA)
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Do hepadnavirus, herpesviruses, and poxvirus have an envelope?
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Yes
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Which virus is often responsible for "pink eye" (conjunctivitis)?
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adenovirus
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Which SS-linear(-) DNA virus is responsible for "slapped cheeks" rash?
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Parvovirus
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Which is the smallest DNA virus?
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Parvovirus
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Which DNA virus can cause aplastic crises in sickle cell disease?
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Parvovirus (B19 virus)
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Name 3 "naked" DNA virsuses (no envelope)
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Parvo, Adeno, and Papovirus (you have to be naked for a PAP smear
)
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The largest DNA virus, one which can cause "milkmaid's blisters" or molluscum contagiosum (and could be used in germ warfare), is:
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poxvirus
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DNA virus characteristics
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p196
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Papovirus is not linear, but rather ____
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circular, supercoiled
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The only DNA virus that is not icosahedral is
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Pox (complex)
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All DNA viruses replicate in the nuclear except
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Pox (carries own DNA-dependent RNA polymerase)
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RNA viruses
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p197
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Poliovirus, Echovirus,Rhinovirus, Coxsackievirus, and HAV are all members of which viral family?
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Picornaviruses ("PERCH")
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Picorna-, Calci-, Flavi-, Toga-, Retro-, and Coronaviruses all share which RNA structure?
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SS + linear
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Which SS-linear, nonsegmented RNA virus family is responsible for measles, mumps, and croup?
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PaRaMyxovirus (Parainfluenza-croups; RSV-bronchiolitis in babies; Measles, Mumps)
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Hantavirus, Sanfly/Rift Valley fevers, and California encephalitis are all part of this SS-circular RNA viral family.
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Bunyaviruses
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Orthomyxoviruses include which ubiquitous virus?
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Influenza virus
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HIV and HTLV are both ____ with ____capsid symmetry.
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retroviruses; icosahedral
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What is the #1 cause of fatal diarrhea in children?
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Rotavirus (a reovirus)
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Rabies is caused by this viral family.
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Rhabdoviruses
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Virus family credited with the "common cold"
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Coronaviruses
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Ebola/Marburg hemorrhagic fever are caused by which viral family?
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Filoviruses
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More virology
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p198
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Three naked (nonenveloped) RNA viruses are:
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Calcivirus, Picornavirus, Reovirus (Naked CPR)
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From where to herpesviruses aquire their envelopes?
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nuclear membrane
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From where do enveloped viruses usually acquire their envelopes?
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plasma membranes
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This is the only virus that is not haploid:
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retrovirus (which has 2 identical ssRNA molecules, so considered diploid)
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The only DNA viruses that does not replicate in the nucleus is:
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poxvirus
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The two RNA viruses which do not replicate in the cytoplasm are:
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Influenza virus and retroviruses
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Viral Vaccines
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p198
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Live attenuated vaccines induce humoral and cell-mediated immunity, while killed viruses induce only ____ immunity.
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humoral
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Are MMR (measles, mumps, rubella) vaccines live or killed?
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Live attenuated
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Rabies, influenza, HAV, and Salk polio vaccines are of which type (live or killed)?
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Killed (SalK=killed)
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A recombinant viral vaccine exists for which virus?
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HBV (antigen=HBsAg)
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Worldwide pandemics of influenza virus are in part attributable to which type of viral genetics?
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Reassortment (viruses with segmented genomes exchange segments)
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Viral Pathogens
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p199
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What structural similarity is shared by herpesviruses, HBV, and smallpox virus?
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They are DNA enveloped viruses.
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RNA nucleocapsid enteroviruses include which pathogens?
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poliovirus, coxsackievirus, echovirus, HAV
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The viral pathogens adenovirus, papillomaviruses, and parvoviruses are all what type of viral pathogens?
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DNA nucleocapsid viruses
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Bunyaviruses, Orthomyxoviruses (influenza viruses), Arenaviruses, and Reoviruses are all what type of RNA virus?
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segmented (BOAR)
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Aseptic (viral) meningitis can be caused by which small RNA viruses?
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poliovirus, coxsackievirus, echovirus (and not by two other picoRNAviruses, rhinovirus and HIV)
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Reovirus considered the most important global cause of infantile gastroenteritis
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Rotavirus (ROTA=Right Out The Anus)
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All paramyxoviruses have 1 serotype with this exception:
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parainfluenza virus (4 serotypes)
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Parotitis can be caused by this paramyxovirus:
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mumps virus ("mumps gives you bumps")
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Triad of mumps symptoms are:
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asceptic Meningitis, Orchitis, and Parotitis (MOP)
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Measles virus
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p. 200
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What virus type causes measles?
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paramyxovirus
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What bluish-gray spots on the buccal mucosa are diagnostic of measles
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Koplik spots
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3 Cs of measles
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Cough, Coryza, Conjunctivitis
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3 possible sequellae
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SSPE, encephalitis, giant cell pneumonia. SSPE = subacute sclerosing panencephalitis
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Influenza viruses
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p. 200
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Five facts about Influenza: enveloped/nonenveloped, nuclear material, antigens, infection --> what risk?, protection.
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1. Enveloped 2. ssRNA with segmented genome 3. Hemagglutinin and neuraminidase antigens 4. Risk of fatal bacterial superinfection 5. Protection = killed viral vaccine
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Treatment for influenza A?
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Amantadine, rimantadine, zanamivir, and oseltamivir
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Treatment for influenza B?
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Zanavir and oseltamivir (neuraminidase inhibitors)
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Rabies virus
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p. 200
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Rabies -- _______ (cytoplasmic inclusion) in _______(cell type)
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Negri bodies in neurons
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Rabies -- incubation period
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weeks to 3 months
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Rabies -- most common sources in US
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bat, raccoon, skunk (>dog)
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Rabies travels to the CNS by
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retrograde migration up nerve axons
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Arboviruses
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p. 200
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Arbovirus -- mode of transmission
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Transmitted by arthropods (mosquitoes, ticks)
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Arbovirus -- classic illnesses
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Dengue fever (in SE Asia = hemorrhagic shock syndrome) and yellow fever
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Arbovirus -- members of the family
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flavivirus, togavirus, bunyavirus
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Yellow fever
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p. 200
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Yellow fever is transmitted by ____________
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the Aedes mosquito
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Symptoms of yellow fever
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high fever, black vomitus, and jaundice.
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Yellow fever -- histology
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Liver: councilman bodies (acidophilic inclusions)
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Herpesviruses
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p. 201
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Name the diseases caused by the following Herpesviridae:
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HSV-1
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Gingivostomatitis, keratoconjunctivitis, temporal lobe encephalitis, herpes labialitis
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HSV-2
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Herpes genitalis, neonatal herpes
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VSV
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Varicella-zoster (shingles), encephalitis, pneumonia
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EBV
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Infecious mononuelosis, Burkitt's lymphoma
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CMV
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Cogenital infection, mononucleosis, pneumonia
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HHV-8
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Karposi's sarcoma
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Name the routes of transmission for the following Herpesviridae:
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HSV-1
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respiratory secretions and saliva
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HSV-2
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sexual contact, perinatal
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VSV
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respiratory secretions
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EBV
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respiratory secretions, saliva
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CMV
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congenital, transfusion, sexual contact, saliva, urine, transplant
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HHV-8
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sexual contact
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Mononucleosis
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p.201
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Mononucleosis is caused by _______
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EBV
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symptoms of mono
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fever, hepatosplenomegaly, pharyngitis, and lymphadenopathy (esp posterior auricular nodes)
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how do you test for mono?
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heterophil antibody test
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what do you see in the peripheral blood (mono)?
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atypical lymphocytes (cytotoxic T cells)
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Tzank test
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p.201
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What's a Tzanck test?
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A smear of an opened skin vesicle to detect multinucleated giant cells (seen in HSV-1, HSV-2, VSV)
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Hepatitis transmission
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p.201
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Name the type of nucleic acid and the virus type for the following hepatitis viruses:
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|
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Hepatitis A
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RNA picornavirus
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Hepatitis B
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DNA hepadnavirus
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Hepatitis C
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RNA flavivirus
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Hepatitis D
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deta agent -- requires HBsAG as its envelope (coinfection only)
|
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Hepatitis E
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RNA calcivirus
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Name the mode of transmission for the following hepatitis viruses
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|
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Hepatitis A
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fecal-oral
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Hepatitis B
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parenteral, sexual, maternal-fetal
|
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Hepatitis C
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blood (IV drug users)
|
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Hepatitis D
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coinfection with HBV!
|
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Hepatitis E
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enterically; water-borne epidemics
|
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which Hepatitis virus causes a high mortality rate in pregnant women?
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E
|
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which hepatitis virus has a short incubation period?
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A (3 weeks)
|
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which Hep virus has a long incubation period?
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B (3 months)
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which Hep virus has a DNA-dependent DNA polymerase?
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B; reverse transcription also occurs
|
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which pairs of viruses are similar in course, severity, and incubation?
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HAV & HEV; HBV & HCV
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Which virus type infection leads to chronic-carrier-status?
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B, C, and D
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Hepatitis serologic markers
|
p. 202
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If I got a Hepatitis B vaccine (no infection), for what Ab would I have a positive serology?
|
HBsAb
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If I recently had a Hepatitis B infection, for what Ab would I have a positive serology
|
HBsAb and HBcAb (positive during window period)
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What test tells you either that I have a current infection or that I am a chronic Hep B carrier?
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HBsAg
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What test demands that you(the doctor) to tell me to stop having sex with my spouse lest I give them Hep B?
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HBeAg
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What test tells you(the doctor) that I can resume sex with my spouse because I'm not likely to give them Hep B?
|
HBeAb (indicates low transmissibility)
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What is the "window period"?
|
after the actue infection is cleared and before the humoral response produces lots and lots of Ab (HBsAg AND anti-HBs negative; HBcAb positive)
|
|
How big is the Hep B virus
|
42 nm
|
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When can I detect HBV particles by DNA polymerase?
|
during the incubation period and the acute disease period
|
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How can I distniguish between complete recovery from Hep B infection and the chronic carrier state?
|
Complete recovery: HBsAg-neg, HBsAb-pos; Chronic carrier: HBsAb-neg. HBsAb-pos; HBcAb is positive in BOTH states
|
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HIV
|
p. 203
|
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HIV has a ________ genome with __<#>__ molecules of __<nucleic acid>____
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HIV has a diploid genome with 2 molecules of RNA
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HIV: name the "rectangular nucleocapsid protein"
|
p24
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HIV: name the envelope proteins
|
gp41 and gp120
|
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HIV: name the matrix protein
|
p17
|
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HIV: what other important protein hangs out inside the nucleocapsid?
|
reverse transcriptase
|
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Does HIV integrate into the host genome?
|
YES. HIV syntehsizes dsDNA from RNA and integrates the dsDNA into the host genome
|
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HIV diagnosis
|
p. 203
|
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How do I make a diagnosis of HIV?
|
ELISA --> confirmed by Western blot
|
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T or F: HIV testing is always positive 1-2 weeks after infection
|
FALSE. ELISA/Western blot look for viral PROTEINS and can be falsely negative for the first 1-2 months of HIV infection
|
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How can I monitor the effect of HIV drug therapy?
|
HIV PCR/viral load
|
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HIV immunity
|
p. 203
|
|
Who is immune to HIV?
|
homozygous for CCR5 mutation
|
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What % of US caucasians have a slower course of HIV infection because of heterozygosity for the above allele?
|
20%
|
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Persons with ______________ have a rapid progression to AIDS
|
CXCR1 mutation
|
|
Time course of HIV infection
|
p. 203
|
|
HIV become symptomatic _____ after infection
|
3-10 years
|
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Anti-p24 and anti-gp120 increase between _______ after initial infection; after the onset of immunodeficiency, they ___________(increase or decrease)
|
1-2 months; decrease
|
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Opportunistic infections in AIDS
|
p. 204
|
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Name the opportunistic infections seen in the following categories: (for AIDS patients)
|
|
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bacterial
|
TB, Mycobacterium avium-intercellulare complex
|
|
viral
|
HSV, VAV, CMV, PML (JC virus)
|
|
fungal
|
Thrush (Candida albicans), cryptococcosis (cryptococcal meningitis), histoplasmosis, Pneumocystis pneumonia
|
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protozoan
|
toxoplasmosis, cryptosporidiosis
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Prions
|
p. 204
|
|
Multiple choice: Prions are -- 1) infectious proteins ONLY 2) infectious RNA 3) infectious DNA 4) infectious proteins occasionally mixed with nucleic acids
|
1) infectious proteins
|
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Name examples of prion diseases
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CJD, kuru, scrapie, "mad cow"
|
|
Jeopardy style: pathologic prions take on this conformation
|
What is beta-pleated sheet
|
|
Prions are associated with ___________ encephalopathy
|
spongiform
|
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Microbiology -- systems
|
p.204-205
|
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Normal flora: dominant
|
p. 204
|
|
Name the dominant normal flora in each of these areas:
|
|
|
skin
|
Staph epidermidis
|
|
nose
|
Staph aureus
|
|
oropharynx
|
Strep viridans
|
|
dental plaque
|
Strep mutans
|
|
colon
|
Bacteroides fragilis > E. coli
|
|
vagina
|
Lactobacillus, colonized by E. coli and group B strep
|
|
Common causes of pneumonia
|
p. 204
|
|
Name the common causes of pneumonia in the following age groups:
|
|
|
Children (6 weeks to 18 yrs)
|
Virus (RSV), Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae
|
|
Adults (18-40 yrs)
|
Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae
|
|
Adults (40-65 yrs)
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Strep pneumoniae, H. influenze, Anaerobes, Viruses, Mycoplasma
|
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Elderly
|
Strep pneumoniae, viruses, anerobes, H. Influenzae, Gram-negative rods
|
|
An AIDS patient comes into your office with symptoms of pneumonia. What organisms are you considering?
|
Staphylococcus, gram-negative rods, fungi, viruses, Pneumocystis carinii
|
|
A patient in the CCU gets pneumonia. What organisms are you thinking?
|
Nosocomial infections are usually Staphylococcus and gram-negative rods
|
|
The same patient also aspirated some peas prior to getting sick. What organisms do you add to your list?
|
Anaerobes
|
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His domineering wife of this same patient is mad because he also had a viral infection last week. What infectious agents would you now consider?
|
add H. influenzae; another common postviral pneumonia bug is Staph
|
|
The wife is so distressed she goes into labor and gives birth to a 10 lb baby girl, who also gets pneumonia. Does she have the same bug as her dad in the CCU?
|
Neonatal pneumonia is usually due to Group B streptococci or E. coli -- the dad could have the latter.
|
|
Of course, the wife get sick too, but her pneumonia is classified as "atypical." What might she have?
|
Mycoplasma, Legionella, Chlamydia
|
|
Cause of meningitis
|
p. 205
|
|
Name the causes of meningitis in the following age groups:
|
|
|
Newborn (0-6 months)
|
Group B strep, E. coli, Listeria
|
|
Children (6 mo to 6 years)
|
Strep pneumoniae, Neisseria meningitidis, Haemophilus influenze type B, Enteroviruses
|
|
6-60 years
|
N. meningitidis, Enteroviruses, S. pneumoniae, HSV
|
|
60+ years
|
Gram-negative rods, Listeria
|
|
An AIDS patient comes to you with high fevers, stiff neck, and mental status changes. What organisms might be causing his meningitis?
|
Cryptococcus, CMV, toxoplasmosis (brain abscess), JC virus (PML)
|
|
CSF findings in meningitis
|
p. 205
|
|
You do a spinal tap on your patient. The CSF pressure appears to be increased. What type of infectious agent have you eliminated?
|
none. It could be bacterial, TB, fungal, or viral (in viral, CSF pressure is normal to increased)
|
|
You do a quick smear of the spinal tap under the microscope and see increased polys. What type of infectious agent does this suggest?
|
bacterial. In fungal, TB, and viral, you see increased lymphocytes.
|
|
The lab tests show an increase in protein and a decrease in sugar in the CSF. Does that confirm your previous guess or confuse you?
|
Confirms. These findings are seen in bacterial, fungal, and TB infections. In viral infections the protein and sugar concentrations of the CSF are normal.
|
|
Osteomyelitis
|
p. 205
|
|
What population is most likely to get osteomyelitis?
|
children
|
|
What lab test is elevated in osteomyelitis?
|
ESR
|
|
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis
|
|
|
Most people (nonspecific)
|
S aureus -- assume S aureus if no other information
|
|
sexually active
|
Neisseria gonorrhea (rare -- septic arthritis is more common)
|
|
drug addicts
|
Pseudomonas aeruginosa
|
|
Sickle cell Px
|
Salmonella
|
|
Prosthetic replacement
|
S. aureus and S. epidermidis
|
|
Vertebral
|
Mycobacterium tuberculosis
|
|
Urinary tract infections
|
p. 205
|
|
What 2 groups of males are likely to get UTIs?
|
old men with enlarged prostates and baby boys with congenital defects
|
|
What are symptoms of pyelonephritis?
|
fever, chills, flank pain, CVA tenderness?
|
|
What are symptoms of a UTI?
|
dysuria, frequency, urgency, suprapubic pain
|
|
The 2nd most common cause of UTI in young, ambulatory women is __________________
|
Staphylococcus saprophyticus
|
|
Your patient gets a UTI while in the hospital. What organisms do you want to make sure his antibiotics cover while his urine culture is growing?
|
E. coli, Proteus, Klebsiella, Serratia, Pseudomonas
|
|
What are predisposing factors for UTIs?
|
female gender (10:1; short urethra colonized by fecal flora), flow obstruction, kidney surgery, catheterization, gynecologic abnormalities, diabetes, pregnancy
|
|
UTI Bugs
|
p. 206 "SSEEK PP"
|
|
Has a blue-green pigment and fruity odor
|
Pseudomonas aeruginosa
|
|
Two UTI bugs that are nosocomial and drug resistant
|
Pseudomonas aeruginosa and Serratia marcescens
|
|
Leading cause of UTIs
|
Escherichia coli
|
|
What does Proteus mirabilis produce?
|
Urease
|
|
Serratia marcescens produce what color pigment?
|
red
|
|
Large mucoid capsule and viscous colonies
|
Klebsiella pneumoniae
|
|
What do E. coli colonies show on EMB agar?
|
metallic sheen
|
|
2nd leading cause of UTIs in sexually active women
|
Staphylococcus saprophyticus
|
|
Associated with struvite stones and swarming on agar
|
Proteus mirabilis
|