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30 Cards in this Set
- Front
- Back
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LMP1 and EBER staining show high concordance in which of the following lesions?
A. Hodgkin lymphoma B. post-transplant lymphoproliferative disorder C. infectious mononucleosis D. A & B E. A, B, C |
E. A, B, C.
The positive correlation between the two stains is highest when observed in the cells that are of interest. LMP1 has a modest false positive rate which can be overcome by narrowing the observation to the cells of interest. QCCP2, EBV |
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Which of the following subtypes of herpes virus is a possible cause of roseola infantum (exanthem subitum)?
A. HHV6 B. HHV7 C. HHV8 D. A & B E. A, B, C |
D. A & B.
Both HHV6 and HHV7 cause overlapping and similar clinical syndromes. A small percentage of those infected develop the characteristic roseola infantum rash. In addition, they are both responsible for a significant number of cases of juvenile febrile seizures, presumably due to their tropism for the CNS. QCCP2, HHV6 |
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Which of the following clinical presentations is associated with HHV8?
A. Kaposi sarcoma B. primary effusion lymphoma C. multicentric Castleman disease D. A & B E. A, B, C |
E. A, B, C.
Especially in the immunocompromised patient, HHV8, or KSHV, is responsible for a number of disease processes. The etiologic agent in these cases is identified by FISH, PCR, IHC, or serological means. QCCP2, HHV8 |
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Members of which of the following families of viruses are responsible for progressive multifocal leukoencephalopathy and viral hemorrhagic cystitis?
A. herpes viruses B. picornaviruses C. reoviruses D. papovaviruses E. bunyaviruses |
D. papovavirus.
The papovaviridae are a family of DNA viruses including the papilloma viruses, polyoma viruses, and vacuolating viruses (SV40) JC, a member of the polyoma virus family, is responsible for progressive multifocal leukoencephalopathy, while another polyoma virus, BK, can cause hemorrhagic cystitis. The BK-induced cystitis is notable for the presence of virus-infected “decoy” cells, so named because they can be easily confused for exfoliated high-grade urothelial carcinoma. QCCP2, Papovaviruses |
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Benign HPV-associated lesions are associated with this form of the virus:
A. integrated B. episomal C. mitochondrial D. extracellular E. intralysosomal |
B. episomal.
In most benign HPV lesions, the virus DNA is maintained in circular extrachromosomal episomes. The process of integration into the host genome by HPV is more often associated with malignant disease. QCCP2, HPV |
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Which disease is associated with an inherited defect in the ability to defend against several HPV subtypes?
A. Li-Fraumeni B. recurrent respiratory papillomatosis C. progressive multifocal leukoencephalopathy D. post-transplant lymphoproliferative disorder E. epidermodysplasia verruciformis |
E. epidermodysplasia verruciformis.
An autosomal recessive condition mapped to a gene on chromosome 17, EV manifests with upper extremity lesions within the first 10 years, which can progress to invasive squamous cell carcinoma. QCCP2, HPV |
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Oral squamous papillomas, laryngeal papillomas, condyloma acuminatum, and low-grade cervical squamous intraepithelial lesions are associated with this/these type/s of
HPV: A. HPV6 B. HPV11 C. HPV16 D. A & B E. A, B, C |
D. A & B.
Subtypes 6 and 11 are often associated with low-grade lesions, while the more oncogenic subtypes, such as 16 and 18, are associated with the higher-grade lesions. HPV18 is most commonly associated with cervical adenocarcinoma. QCCP2, HPV, T3.11 |
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In a person vaccinated against hepatitis B virus several years prior, which serological marker would be expected?
A. HBsAg B. HBeAg C. IgG anti-HBc D. HBsAb E. anti-HBc |
D. HBsAb.
All of the other choices, with perhaps the early appearance post-vaccination of HBsAg, should not be seen in a vaccinated individual. HBeAg is present during active viral replication, while anti-HBc is present only in someone who has resolved an acute infection. It is the same with anti-HBe, though this is less associated with resolution than with someone who has just had the HBeAg turn negative in testing. QCCP2, HBV |
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The persistence of which marker is the best evidence of chronic HBV infection:
A. HBeAg B. HBsAg C. anti-HBe D. anti-HBs E. anti-HBc |
B. HBsAg.
The persistence of surface antigen is an excellent indicator of chronicity. With acute infection and resolution, surface antigen peaks 2-3 months post-infection and before symptoms, but is completely gone before 6 months, to be replaced by anti-surface antibody (HBsAb) and the clinical symptoms of acute hepatitis. In chronic infection, the surface antibody does not appear, while the surface antigen persists. QCCP2, F3.2 - 3.3 |
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To what does the “window period” of HBV infection refer?
A. the period between the appearance of HBV DNA and infection B. the period between the disappearance of HBsAg and appearance of HBsAb C. the period between the disappearance of HBcAg and appearance of HBcAb D. the period between HBeAg and HBcAg E. the period between infection and IgM anti-HBcAb |
B. the period between the disappearance of HBsAg and appearance of HBcAb.
Less sensitive assays of the past may have missed the diagnosis of HBV if performed in the brief period around 5-6 months post-infection. Serologically, this corresponds to the period between the disappearance of the surface antigen and the appearance of the surface antibody. Nowadays, we can measure IgM anti-HBc during this time period and expect it to be positive. QCCP2, HBV |
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Which HBV antigen has been used to characterize chronic HBV carriers as either replicative or non-replicative?
A. HBc B. HBs C. HBe D. HBx E. HBp |
C. HBe.
In the past, HBe antigen was used to classify patients. However, there are issues with the consistency of HBe serology, so now the measurement of HBV DNA copy number has replaced HBe. A copy number of >105/mL is needed to classify a chronic HBV carrier as “replicative.” QCCP2, HBV molecular assays |
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What percentage of people infected with hepatitis C virus will go on to chronic infection?
A. <5% B. 25% C. 50% D. 85% E. >99% |
D. 85%.
The vast majority of people infected with HCV develop chronic infections. Of these, 10-15% become cirrhotic, and of the cirrhotics, 5% (if non-drinkers) will develop hepatocellular carcinoma. Alcohol consumption greatly increases the risk of HCC, especially in the cirrhotic with chronic infection. QCCP2, HCV |
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Which of the following scenarios might explain a conflicting set of results in a patient with a positive anti-HCV antibody result and negative HCV RNA PCR?
A. no infection B. no infection or recovery from acute HCV C. early HCV D. chronic HCV E. infection |
B. no infection or recovery from acute HCV.
A positive anti-HCV could be either a false positive, in the case of non-infection, or it could indicate the patient was one of the 15% of cases where HCV did not develop chronic infection. QCCP2, HCV |
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How is a sustained virological response or a positive HCV treatment outcome defined?
A. complete absence of detectable HCV RNA for perpetuity B. disappearance of anti-HCV antibody C. no evidence of chronic HCV on liver biopsy D. undetectable HCV RNA for 24 weeks E. greater than 10-fold reduction in HCV RNA |
D. undetectable HCV RNA for 24 weeks.
A sustained virologic response (SVR) is used to define patients who have responded positively to treatment (IFN/ribavirin). The single most important prognostic predictor of response to IFNs is the genotype of HCV. Types 2 and 3 respond well while type 1, the more common type seen in the U.S., tends to respond poorly. QCCP2, HCV |
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Which is the best test for determining the likelihood of progression to cirrhosis in a patient with chronic HCV?
A. liver biopsy B. quantitative HCV RNA C. qualitative HCV RNA D. serial ALT levels E. HCV serotype determination |
A. liver biopsy.
All of the tests mentioned have a role in the diagnosis and management of HCV. However, only liver biopsy can provide the data required to grade inflammation and stage fibrosis of liver infection. QCCP2, HCV |
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Which of the following hepatitis viruses requires coinfection or chronic infection with HBV in order to infect the liver?
A. HAV B. HCV C. HDV D. HEV E. HGV |
C. HDV.
HDV can only infect hepatocytes that are infected with HBV. Coinfection of patients with HBV and HDV results in a more severe disease and significantly increases the risk of cirrhosis and hepatic failure. |
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Which of the following viruses is hemagglutinin-positive?
A. influenza A B. influenza B C. parainfluenza D. A & B E. A, B, C |
E. A, B, C.
A viral surface protein, hemagglutinin, binds to sialic acid receptors on the surface of respiratory epithelial cells and in turn are expressed on the surface of infected cells. The hemagglutinin has the ability to agglutinate red blood cells, which is the basis of the diagnostic hemadsorption test. QCCP2, Orthomyxoviruses |
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Which of the following influenza subtypes is associated with pandemic avian influenza?
A. H1N1 B. H5N2 C. H5N1 D. H2N1 E. H2N2 |
C. H5N1.
There are currently over 15 H and 9 N subtypes, with the numbers growing steadily due to antigenic shifts. Birds are the more common reservoir for influenza, for example, the chickens in S.E. Asian H5N1 avian influenza. The virus can cause an ARDS clinical appearance with a 50% mortality, predominantly affecting teenagers. QCCP2, Orthomyxoviruses |
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Which of the following tests for influenza is considered the gold standard?
A. culture B. direct fluorescent antibody C. detection of influenza RNA D. serology E. rapid Monospot |
A. culture.
Nasopharyngeal, sputum, or throat samples can be used to culture virus, either in cell culture or in the more rapid shell vial assay. All the other tests mentioned, with the exception of the Monospot test, have shown utility in the diagnosis of influenza. QCCP2, Orthomyxovirus, diagnosis |
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What's the most common secondary complication that can arise with measles infection?
A. otitis media B. pneumonia C. myocarditis D. appendicitis E. subacute sclerosing panencephalitis |
A. otitis media.
Superinfection can cause otitis media or pneumonia, especially in immunocompromised patients. All of the other choices can happen with measles infection but for the most part are rare, especially SSPE. QCCP2, Measles |
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What name is given to the characteristic measles-infected cell in the lungs or appendix?
A. Anitschow cell B. Touton giant cell C. floret cell D. Warthin-Finkeldey E. Hallmark cell |
D. Warthin-Finkeldey cell.
The Anitschow cell is seen in rheumatic fever. The Touton giant cell with its wreath-like arrangement of nuclei can be seen with several lesions, including juvenile xanthogranuloma and atypical fibroxanthoma. The floret cell is seen with pleomorphic liposarcoma and the hallmark cell is usually associated with anaplastic large cell lymphoma. QCCP2, Measles |
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This virus is responsible for nearly all cases of infantile respiratory bronchiolitis:
A. parainfluenza virus B. influenza A virus C. metapneumovirus D. Coxsackie A virus E. respiratory syncytial virus |
E. respiratory syncytial virus.
Respiratory syncytial virus also causes 1/2 of all cases of lower respiratory tract infections in children. Persistence of immunity does not often occur, so reinfection is common. Among other techniques, the characteristic formation of syncytia in Hep-2 cells is used in the diagnosis of RSV. QCCP2, RSV |
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What is the gold standard assay for the diagnosis of enteroviral meningitis in CSF samples?
A. cell culture B. RT-PCR C. direct fluorescent antibody D. EIA E. suckling mouse paralysis assay |
B. RT-PCR.
As of now, RT-PCR is the most rapid and sensitive assay available for the detection of enterovirus in the CSF. However, backup culture should be done in tandem as well. DFA and EIA are not commonly used, and I just wanted an excuse to use the suckling mouse assay again, which you may recall can be used in the diagnosis of Coxsackie A, an enterovirus. QCCP2, Picornaviruses |
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What is notable about the culture of rhinovirus?
A. several weeks of incubation B. culture must contain support virus C. high salt media is needed D. requires addition of nasal mucus to culture E. must be incubated at 32°C |
E. must be incubated at 32°C.
The only unique property of rhinovirus is that it should be cultured in a temperature slightly lower than body temperature. The thought of adding nasal mucus to a culture is a little more than I can bear. QCCP2, Rhinovirus |
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What does hantavirus and the Crimean-Congo hemorrhagic fever viruses have in common?
A. they are members of the bunyavirus family B. they are arthropod-borne C. they are found in geographically overlapping areas D. they have extremely long latency E. they have DNA-based genomes |
A. they are member of the bunyavirus family.
Hantavirus and the Congo-Crimean hemorrhagic fever virus are both members of the bunyavirus family, along with other hemorrhagic fever viruses, such as Rift Valley fever and La Crosse viruses. Most other hemorrhagic fever viruses belong to other virus families, such as the filoviruses Marburg and Ebola. QCCP2, Family Bunyaviridae |
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Why are yellow fever and rubella viruses different from the other members of the togavirus family?
A. they have DNA genomes B. they have hybrid RNA-DNA genomes C. they require coinfection with another virus D. they do not cause arthropod-borne encephalitis E. they both primarily infect the liver |
D. they do not cause arthropod-borne encephalitis.
Yellow fever and rubella virus are both RNA virus members of the Togaviridae. Unlike all other togaviruses, such as alphaviruses and other flaviviruses, they are not predominantly arthropod-borne causes of encephalitis. Yellow fever favors the heart, GI tract, liver, and kidneys, while rubella causes lymphadenopathy and rash. QCCP2, Family Togaviridae |
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All of the following are potential consequences of in utero rubella infection, except:
A. glaucoma B. congenital heart disease C. sensorineural deafness D. microcephaly E. midzonal hepatic necrosis |
E. midzonal hepatic necrosis.
Congenital rubella is a potentially devastating infection, especially if acquired in the first trimester. While hepatosplenomegaly can occur, midzonal necrosis is not seen. It is, however, a prominent feature of yellow fever infection. QCCP2, Rubella virus |
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Which of the following mosquitoes transmit both yellow fever and Dengue fever viruses?
A. Aedes aegypti B. Aedes albopictus C. Culex pipiens D. A & B E. A, B, C |
D. A & B.
The Aedes mosquitoes are responsible for transmission of the viruses that cause yellow fever and Dengue fever, as well as some of the causative agents of filariasis and viral encephalitis. Culex pipiens is also a vector for many of the Arboviridae, such as Eastern and Western equine encephalitis, but it is not been shown transmit yellow or Dengue fever viruses. QCCP2, Dengue and yellow fever |
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Negri bodies in Purkinje cells are associated with which of the following viruses?
A. paramyxoviruses B. Eastern equine encephalitis C. rhabdovirus D. lymphocytic choriomeningitis virus E. Ebola virus |
C. rhabdovirus.
Rabies virus is transmitted through bites by contaminated animals. In most of the world, that means dogs and cats. In areas where the domestic causes are controlled, non-domestic animals, such as bats, skunks, and foxes are responsible for the transmission of the majority of cases. QCCP2, Family Rhabdoviridae, |
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All of the following are endemic areas for the human T cell lymphotropic virus - I, except:
A. Norway B. Caribbean C. S. Japan D. Brazil E. S. Africa |
A. Norway.
HTLV-I is spread primarily through IV drug use and sexual contact. It is the causative agent of the demyelinating disease, tropical spastic paraparesis and adult T cell lymphoma through the infection of CD4+ T cells. QCCP2, HTLV-I |
