Viral Hepatitis Sti/stds Infectious Diseases

Front 1

can be a primary or secondary manisfestation of several infections (Yellow fever, EBV, HSV, CMV, Lassa Fever) and/or noninfectious conditions (alcoholic cirrhosis)

Back 1

viral hepatitis

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inflammation of the liver

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viral hepatitis

Front 3

RQ: detectable signs of viral hepatitis

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RQ: elevated liver enzyme levels, jaundice (icterus), malaise, fever

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primary viral hepatitis agents

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Hepatitis A-G

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Hepatitis A Virus (HAV)
aka ...
taxonomic group?

Back 5

enterovirus 72 of the picornaviradae

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Hepatitis B Virus (HBV)
TQ: *RNA or DNA?*
which taxonomic group?

Back 6

TQ: *DNA* virus of the Hepadnaviradae

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Hepatitis C Virus (HCV)
aka...
taxonomic group?

Back 7

nee NonAnonB (NANB) an enteriovirus

Front 8

TQ: Hepatitis D Virus (HDV)
*aka..*.
RNA or DNA?
taxonomic group?

Back 8

TQ: *aka Delta agent*
defective RNA virus
currently only member of Deltaviridae

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Hepatitis E Virus (HEV)
taxonomic group?

Back 9

provisionally in caliciviridae

Front 10

TQ: Hepatitis F (HFV)
variant of what virus?

Back 10

TQ: variant of HBV

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TQ: Hepatitis G Virus (HGV)
homologous to ...

Back 11

TQ: 25% homologous to HCV genome but doesn't cause symptoms

Front 12

HAV
how many serotypes?
enveloped or not?
thermotolerant or not

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single serotype,
unenveloped- since's there's no envelope it's thermotolerant and cold tolerant
acid stable

Front 13

TQ: how is HAV spread?

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TQ: it's in stool 2-3 weeks before and 1 week after jaundice
*fecal-oral* or contaminated food (*shellfish*) or *water*, oro-anal sex

Front 14

why is parenteral transmission of HAV rare?

Back 14

parenteral "around the gut"
rare b/c of short viremic phase

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where does HAV grow then spread and multiply

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assumed to grow in intestinal epithelium then spread to liver and multiply in parenchymal cells

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which antibody responds first to HAV?
TQ: is there life-long immunity to HAV?

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TQ: IgM - largest, most efficient. then switches to IgG -giving *life long immunity*

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is HAV a zoonoses

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no, shellfish are intermediate hosts, use chimps as experiemental hosts

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does severity of HAV increase or decrease with age?

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increases: 75% of adult cases have jaundice
childhood infection tend to be anicteric (milder)- less jaundics cases

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is mortality of HAV high or low

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low. 90% of pts recover fully w/in 3 months
5% have recurrence of milder dx, then recover

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TQ: do people chronically carry HAV

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TQ: no, *no chronic carrier state* known. endemicity requires sporadic subclinical infection

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responsible for 25% of clinically apparent hepatitis worldwide

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HAV

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highest incidence of HAV found in which populations

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Amer. Indians, Alaskan natives, institutionalized children and in daycare

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in undeveloped countries when do people have anti HAV antibodies?
how by are seropositive by 50 yrs in developed countries?

Back 23

undevl. most have antibody by 10 yrs
devel. 50% seropostive by 50 yrs old

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what's given in the passive immunization of HAV? is it long term or temporary

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Immune Serum Globulin, it's expensive and temporary but you won't become ill and doesn't interfere with natural immunization

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who's given the HAV vaccine?
is it active or inactive?

Back 25

inactivated formalin, universally recommended b/c it's less expensive.
Before it was given at 2 yrs, recommended for those at risk and living in states with high annual incidence (CA)

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TQ: *HBV is also known as or causes what?*
how is it spread?

Back 26

TQ: *serum hepatitis*
spread from sexual contact (50%) or from blood transfusion

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is HBV a zoonoses?

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no but it can infect chimps and gibbons - can't be cultured b/c cells don't retain wild type markers used for viral attachment

Front 28

RQ: Dane particle is associated with what virus?
how many layers does it have
DNA or RNA

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RQ: HBV
two layers
dsDNA

Front 29

what is strange about the DNA of HBV?

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one of the strands is incomplete so that 15-50% is single stranded
has 4 genes
DNA polymerase with reverse transcriptase activity

Front 30

what antigens are associated with HBV?

Back 30

HBsAg = surface antigen (AKA Australia antigen)
HBcAG, HBeAg = core antigens

Front 31

chronic carriers of HBV have a large excess of what antigen? - it's a source of HBV vaccine antigen

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HBsAg, a positive or prolonged presence indicative of carrier status and a way to diagnose

Front 32

how do you tell when a person + for HBV has a low risk of transmission?
when does it "arise"

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when anti-HBeAb is found in high amounts, "arises" during incubation
HBcAg and HBeAg are dimers

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how long is the incubation of HBV?

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long: 6 weeks to 6 months (average is 10 weeks)

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what's going on in the proliferative phase of HBV?

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viral DNA in hepatocyte - actis as an episomal template (part of the chromosome) for complete virions but replication is inefficient, makes more empty capsids than comple virions

Front 35

what happens in hepatocytes infected by HBV that are not destroyed by the host's immune system?

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viral DNA may be integrated with host DNA, stops viral replication and liver damage
still have risk of hepatocellular carcinoma (Primary Liver Cancer)

Front 36

which phase of HBV includes jaundice?

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icteric (preicteric, icteric, convalescent)

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symptoms of preicteric (prodromal) HBV

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malaise, lethargy, anorexia, nausea, vomiting, abdominal and upper right quandrant pain

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what might you find in an HBV patient in the icteric phase?

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bilirubinemia and bilirubinuria (dark urine) followed by jaundice

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HAV and HBV are dramatically differnt in that the convalescent stage may be protracted with malaise lasting for weeks, months, or in older folks-a year

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HBV - malaise lasting for weeks, months or longer

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the severity of HBV is affected by 3 things:

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1. portal of entry-needle most serious
2. infective dose (0.0001mL sufficient for disease)
3. intensity of host's CMI response (massive response produces more severe disease but assoc w/ lower carrier rate)

Front 41

what are the 6 outcomes of HBV

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1. transient subclinical infection
2. acute hepatitis
3. fulminant hepatitis
4. healthy carrier
5. persistent infection
6. chronic active hepatitis

Front 42

which HBV 'outcome' is fatal

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fulminant hepatitis

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are transient subclinical HBV infected people healthy carriers or non-infective

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they are not healthy carriers and are non-infective

Front 44

what antigen is found in HBV healthy carriers?
how often are they fully resolved?

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HBsAg
50% are resolved, others remain as asymptomatic carriers for life

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do most persistant HBV infections resolve?
what can they develop into?

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extrahepatic disease (polyarteritis nodosum, glomerulonephritis)
Chronic active hepatitis (10-30%)

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TQ: chronic active hepatitis from HBV can progress into..

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TQ: *cirrhosis* or *primary hepatocellular carcinoma (PHC)*

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TQ: when are most HBV infections acquired

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TQ: early in life: *perinatally* (not transplacentally)
{HBV- B for Birth}

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TQ: how is HBV virus shed from healthy carriers

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TQ: semen, saliva, tears, breast milk (*not stool*)

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TQ: are many of those infected with HBV at birth become chronic carriers

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TQ: 95% - develop either chronic active hepatits, cirrhosis, or PHC

Front 50

what reduced the infection of HBV

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RIA blood screening

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TQ: how is HBV 'historically transmitted'?

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TQ: tatooing, piercing, venereally, *IV drug use*, *blood transfusions*

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TQ: how is HBV prevented?

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TQ: *Recombivax*~recombinant subtype vaccine - given to baby, can be given 12 hours after birth
~HBIG (hep B immunoglobulin) - given to mom or others that may have been exposed

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is HCV RNA or DNA, ss or ds?
enveloped or not

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ssRNA
enveloped

Front 54

what was HCV's former name

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NonA NonB

Front 55

TQ: which Hepatitis strain is most known for *post-transfusion hepatits (PTH) and IV drug use*

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TQ: Hepatitis C

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TQ: most frequent reason for liver transplant

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TQ: HCV (leading cause of liver disease in the Western world) {lame mneumonic: C as in Cut you open for a new liver, tell me you won't remember that!}

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TQ: what's a characteristic feature of HCV?

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TQ: *episodic elevation of liver enzymes/they're sometimes normal

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TQ: is jaundice with HCV more or less severe than HBV?

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TQ: less severe jaundice but more frequently leads to chronic active hepatitis--> *cirrhosis in 5-10 years*
~*HCV is also most frequent reason for liver transplant in the US*

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TQ: what is done for the prevention or to cure HCV?

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TQ: no cure or prevention b/c the *virus is unstable* --many variants

Front 60

TQ: *high titers of what do not protect against subsequent infection or recurrent illness from endogenous strain?

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TQ: anti-HCV IgG

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TQ: HDV aka...

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TQ: Delta agent

Front 62

the capsid of HDV has which antigen

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HBsAg

Front 63

TQ: HDV is entirely dependent on what for its survival

Back 63

TQ: *HBV for reverse transcriptase

Front 64

TQ: when a person has a superinfection with HDV, what other disease is often included?

Back 64

TQ: HBV
TQ: HDV can only be transmitted from *host to host* that's what Johnny said was a test question

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TQ: what could be the outcomes of HDV/HBV superinfection

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TQ: *self-limiting*, *high rate of chronic active hepatitis*, or severe hepatitis (high mortality)

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TQ: where is HDV commonly found?

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TQ: *{think D for desert} *africa, middle east, southern italy (also russia, romainia, parts of S. america)

Front 67

where is HBV commonly found?
TQ: is HDV found there also

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China and South east Asia
TQ: No, ironically HDV is not common there

Front 68

who has HDV in the US?

Back 68

IV drug users (in NE) and hemophiliacs (from blood transfusions)

Front 69

is HEV DNA or RNA?
enveloped or not
TQ: member of what taxonomic group?

Back 69

ss RNA
nonenveloped
TQ: *Caliciviridae* {remember CALI: cal-E}

Front 70

TQ: how is HEV spread?
TQ: who is most commonly affected?

Back 70

TQ: ~*fecal-oral, like *HAV {mneumonic:E, E, E for feeeecal. HAV: A: anus (assoc w/ fecal matter), TV channel A&E}
TQ: ~ *young adults most commonly affected*

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TQ: what are some similiarities and a difference b/t HEV and HAV?

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similarities: fecal-oral, acute and often severe dx *w/out chronic sequelae*), uncommon in children

TQ: differences: *HEV high mortality rate among pregnant women*, *HEV uncommon in elderly*
{don't worry.. about HEV.. if you're elderly. but oh no.. if you're prego} you're all going to ace this test with my rhyming skillz

Front 72

why are STDs now called STIs?
can any come from animals/zoonoses?

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~b/c many are acute or asymptomatic
all are infectious
~no zoonoses

Front 73

Herpes Simplex Virus-I (HSV-I)
4 conditions:

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herpes labialis
gingivostomatitis
keratoconjunctivitis
encephalitis and meningits

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HSV-2
2 conditions:

Back 74

genital herpes
herpes neonatorum

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do any STIs evoke permanent portective immunity?

Back 75

NO

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Herpes Virus:
DNA or RNA?
enveloped or not?

Back 76

dsDNA
enveloped

Front 77

TQ: is Herpes Virus prevalent?
does Herpes Virus persist in the host indefinitely?

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TQ: ~yes, very prevalent -almost everybody has become infected *familial transmission* but majority not symptomatic
~yes, you have the host indefinitely but it's typically latent.
*recurrent symptoms associated with immunosuppressive therapy*

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where does the HSV multiply?

Back 78

slowly in the nucleus of the host cell so it doesn't kill it
buds from nuclear membrane

Front 79

TQ: how can you tell the area where HSV is replicating?

Back 79

TQ: *a histopathological lesion* - intranuclear inclusions idential (*Cowdry type A*) [i don't know what that means]

Front 80

what virus is most responsive to chemotherapy?

Back 80

herpes viruses- only for symptomatic relief

Front 81

TQ: how do primary infections of HSV present?
what are recurrences called?

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TQ: ~*often inapparent*- you can have it awhile before having symptoms
~*it's considered reactivation, not reinfection* (b/c you have it for life)

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what is the portal of entry for HSV?
TQ: *where are virions shed from?

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~skin and mucus membranes-direct contact
TQ: ~virions shed in *saliva*

Front 83

TQ: what the most common disease manisfestation caused by HSV-1?
when is it acquired?

Back 83

TQ: ~*herpes labialis - 70% of pop seropositive by 45 y/o
~acquired early in life

Front 84

TQ: what manisfestation of HSV-1 is moslty seen in young children?
what are the symptoms?
TQ: how does it present in young adults?

Back 84

~gingivostomatitis
TQ: ~children: fever, drooling, sore mouth (b/c of *pharyngeal erythema* and edema), mouth and gums covered with vesicles that rupture (*resemble chicken pox*)
TQ: ~young adults: *pharyngitis* or tonsillitis (also occurs with genital herpes with orogenital contact)

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TQ: what are complications AIDS patients might have if also infected with HSV-1?

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TQ: *esophagitis*-acute onset, painful, difficult swallowing, substernal pain
can get secondary candidiasis

Front 86

TQ: where is HSV-1 retained for life?
how does it reappear?

Back 86

TQ: in sensory nerve root ganglia of the *trigeminal nerve* - stressors may reactivate disease --> cluster of vesicles around the mucocutaneious junction of the lips

Front 87

TQ: what manisfestation of HSV-1 can cause blindness?
how might you get it?

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TQ: keratoconjunctivitis- from autoinoculation (from yourself)
dendritic ulcer of cornea and conjunctiva -->scarring -->blindness (*most common cause of corneal damage and blindness in the industrialized world*)

Front 88

what is the rare but fatal manisfestation of HSV-1?

Back 88

encephalitis and meningitis - currently the major cause of fatal sporadic encephalitis in US, survivors suffer permanent neurological damage

Front 89

TQ: what are some local symptoms of HSV-2?
TQ: what are some systemic symptoms?

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TQ: ~local: painful vesiculopustular lesions -burst and form *genital ulcers*; in females-discharge, itching, *inguinal lymphadenopathy*
TQ: ~systemic: fever, malaise, myalgias, *photophobia*, small amt may develop menigitis

Front 90

TQ: *where is HSV-2 retained in your body?
*are recurrences more common with HSV-1 or 2

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TQ: *lumbar and sacral sensory ganglia* {remember Dr. Dain's drawing of roman numeral two, II -->between the legs}
~*more common recurrences with HSV-2 but episodes are shorter and milder* *self-limiting*

Front 91

primary infection may be subclinical but severe disease often occurs, esp in females

Back 91

HSV-2

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does HSV-2 cause cervical carcinoma?

Back 92

no, but there is a high association. may be a cofactor for development of cancers but is not likely to be a sole cause of it

Front 93

TQ: is herpes neonatorum passed transplacentally?

Back 93

TQ: no, herpes 2 *doesn't cross the placenta*
*greatest risk is when there's a primary maternal infection during labor*

Front 94

TQ: what is the most common infection worldwide?
~what number Herpes virus is it? HHV_

Back 94

TQ: Epstein-Barr Virus (aka Human Herpes Virus 4: *HHV4)* 90-95% of adults are seropositive

[chicken pox is HHV3]

Front 95

TQ: ~*what do half of those infected with Epstein-Barr virus develop?
~*heterophile + or -?

Back 95

TQ: ~*infectious mononucleosis* (*aka glandular fever*)
~*heterophile + {mneumonic: going to the bar is a positive experience: Barr, hetero +}

Front 96

how is Epstein-Barr virus spread?
is it contagious with "household contacts"?

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~oral contact, virus is in saliva and B cells (not in feces, urine or genital secretions)
~not very contagious with household contacts- the secret to its success is that only some people have symptoms and they shed the virus months after recovery

Front 97

most common manifestation of Epstein-Barr virus infection?

Back 97

infectious mononucleosis (gladular fever)-initial development in lymphoid tissue of oropharynx (esp tonsils) hard to distinguish from other infections

Front 98

what is the target cell for Epstein-Barr virus resulting in infectious mononucleosis?

Back 98

B lymphocyte - the envelope glycoprotein attaches to CD 21 receptor on the B cell (polyclonal activation)
causes them to proliferate and make plasma cells and antibodies but not neccessarily the right ones- takes lots of energy (why pt is tired)

Front 99

TQ: symptoms of infectious mononucleosis (EPV)
willl they have life long immunity to recurrence?

Back 99

TQ: -fever (104F or 40 C)
-convalescence, depression, don't want to overexert self
-sore throat
-enlarged lymph glands
-*hepatosplenomegaly* (elevated enzyme levels (AST, ALT) *mimics viral hepatitis*
~most have life long immunity to recurrence

Front 100

what is seen in immunosuppressed (impaired Tc cell activity) in someone with Epstein-Barr Virus?

Back 100

progressive lymphoproliferative disease

Front 101

who develops progressive lymphoproliferative disease from Epstein-Barr virus?

Back 101

-kids with primary immunodeficiency (SCID-severe combined immunodeficiency)
-transplant pts on cyclosporin A (drug that suppresses T cells)
-AIDS pts

Front 102

TQ: *E. Africa'*s most common childhood cancers -affects node in jaw

Back 102

TQ: *Burkitt's lymphoma* -associated with *Epstein-Barr virus*
the kids are immunosuppressed b/c of malaria

Front 103

two cancers associated with Epstein-Barr virus

Back 103

~Burkitt's lymphoma-E. Africa, affecting nodes in jaw
~Nasopharyngeal Carcinoma (NPC)-most common cancer in certain parts of China, SE Asia, Africa and eskimos

Front 104

aka Human Herpes Virus 5 (HHV5)
is it better to 'get this' as a child

Back 104

~cytomegalovirus- about 40% in US are seropositive, up to 100% in undeveloped countries
~usually subclinical if acquired during early childhood

Front 105

what does cytomegalic inclusion disease (CID) resemble? {Boss will try to confuse you with SCIDS: associated with Epstein-Barr Virus/progressive lymphoproliferative dx}
TQ: symtoms of CID?

Back 105

~resembles *erythroblastosis foetalis*:Rh incompatible dx b/t mom and baby, but CID can't be "cured" with transfusions. *infant can shed virus for years
TQ:~*hepatosplenomegaly*, CNS abnormalities (hearing, IQ), *jaundice*, thromobcytopenia, petechiae, pneumonities (but only 10-20% infect manifest with some signs of disease)

Front 106

TQ: what the major viral cause of congenital abnormalities?

Back 106

TQ: cytomegalovirus : causing cytomegalic inclusion disease (CID), infant can shed virus for years

Front 107

how can cytomegalovirus be spread?

Back 107

during delivery or from breast milk
mostly asymptomatic, possibly b/c infant acquired mom's antibodies

Front 108

TQ: how are EBV mononucleosis and CMV mononucleosis different?

Back 108

TQ: EBV : *pharyngitis and lymphadenopathy. CMV-neither of those
CMV- *heterophile - (heterophile antibody is absent) {lame mneumonic CMV sounds like DMV, which is well known as being a negative experience DMV-->CMV heterophile -}
EBV heterophile +{a Bar is a + positive experience}

Front 109

how is cytomegalovirus shed?
is it spread for life?

Back 109

~in saliva: urine, semen, cervical secretions, breast milk, transplanted organs
~shed intermittently for life

Front 110

TQ: how does risk of infecting unborn baby with cytomegalovirus increase?

Back 110

TQ: if mom has CMV before preganancy-baby has little chance of getting it
-big risk if mom gets mono whle pregnant, but most asymptomatic b/c *mom passes on antibodies*

Front 111

TQ: how can CMV be passed on?

Back 111

TQ: *intrauterine* (transplacentally?), *perinatal* (during delivery, breast feeding), oral contact with fomites (esp in day cares), venereal, blood transfusion
{CMV- M- Mom's uterus & V- vagina}

Front 112

most frequent cause of transfusion-acquired mononucleosis

Back 112

CMV cytomegalovirus

Front 113

is Human Papillomavirus (HPV)
DNA or RNA?
enveloped or not?
which taxonomic group?

Back 113

dsDNA, nonenveloped, Papovaviridae

certain types infect certain types of tissues-(papillomas or warts: common, flat, plantar anogenital and laryngeal papillomatosis)

Front 114

TQ: second leading cause of cancer related death in women (after lung cancer)

Back 114

TQ: *Human Papillomavirus -->cervical cancer*
implicated in development of squamous cell dysplasias and carcinomas of the genital tract

Front 115

TQ: how does cancer develop from HPV?

Back 115

TQ: ~infection of basal cells in strat. squamous epithelium - causes proliferation
~*Koilocytosis -a cytopathic effect: enlarged vacuolated cytoplasm with shrunken nuclei*

Front 116

TQ: *condyloma acuminatum aka...
how does it grow?
how does it metastasize?

Back 116

~* aka anogenital warts* from HPV {the only semi helpful way to remember it is to think of condyleeza rice, it's more helpful if you don't like the Bush administration} {keep this straight from condylomata lata- which if from syphilis}
~exophytic growth (grows outward) but also grows into myometrium
~can metastisize through lymph

Front 117

TQ: which types of HPV are most common?
~*which accounts for most of the cancer cases?*

Back 117

TQ: HPV 16 and 18
*HPV 16 accounts for half of cancer cases*

Front 118

TQ: typical form of anogenital warts:
*atypical form:
treatment:

Back 118

~typical: soft, raised, fleshy, lesions (HPV 6, 10, 11, 40-45)
~atypical:flat (*HPV 16*, 18, 31) TQ: *associated with increased risk of cervical, penile and anal carcinoma*
~treatment:caustics, cauterization or surgical excision

Front 119

TQ: most prevalent STI in the US

Back 119

TQ: HPV- but it's not tracked by the CDC

Front 120

TQ: prevention of HPV

Back 120

TQ: *vaccine against HPV 16*, inoculation of virus like particles, done prior to puberty

Front 121

leading cause of death in Africa and 4th leading cause of death worldwide

Back 121

AIDS/HIV

Front 122

is HIV
DNA or RNA?
enveloped or not?
taxonomic group?
+ or - sense

Back 122

~2 copies of ssRNA
~enveloped
~group D Lenitvirus- related to a group of nontransforming cytopathic retroviruses {vs transforming retroviruses that are cancer causing}
~ +sense

Front 123

TQ: how is HIV transmitted?

Back 123

TQ: ~venereally
~IV drug use
~*blood transfusions* *Like HBV but HIV requires greater exposure b/c free infectioius virus is present in small quantities*
~*in utero* (transplacental?) and *perinatal* (*some in breast milk*)

Front 124

TQ: highest risk group for HIV in US and worldwide...
*fastest growing risk group...*

Back 124

TQ: ~in US: homosexual/bisexual males with multiple partners
~worldwide:70-75% of infections acquired heterosexually
*fastest growing risk group is female sex parteners of male IV drug users*

Front 125

this transmission account for almost all childhood cases

Back 125

in utero and perinatal
-all infants of HIV+ moms have antibodies at birth but only 25-40% are infected with the virus

Front 126

TQ: can HIV be passed on by casual contact, air-borne transmission and arthropod vectors (ie mosquitos)

Back 126

TQ: no ( HBV is also not tranmissable this way)

Front 127

what's the 'secret to HIVs success'?
is the incubation time variable?

Back 127

~antigenic diversity
~very variable 2-15 years (avg 5-8 years)
depends on how well you can regenerate T Helper cells

Front 128

TQ: what is the target cell for HIV?
what happens?

Back 128

TQ: ~targets cells with *CD4 receptors* (*T4 or helper lymphocytes*, certain *macrophages*, *monocytes* and *Langerhans cells*)
~viral envelope glycoprotein120-CD4 contact results in conformational change of glycoprotein so it can attach to CCR coreceptor which allows viral entry

Front 129

how does HIV enter cell? (short answer)

Back 129

via receptor-mediated endocytosis or fusion - often involving syncytia or giant cell formation

Front 130

TQ: HIV replication kills what directly and indirectly?

Back 130

TQ: *T4 cells - indirectly via apoptosis
*doesn't kill macorphages and monocytes* but infects them early on-they're used as *vehicles for transport of HIV to lymph nodes and CNS*, they are resistant to cytolytic infection (esp isolated in CNS from immune effector cells)

Front 131

why is there a higher incidence of Pneumocystis pneumonia in AIDS than in other immunosuppressed conditions?

Back 131

poor antigen presentation and defective chemotaxis in infected aleolar macrophage

Front 132

the secretion of what in AIDS patients explains chronic fevers?

Back 132

enhanced secretion of Interleukin-1, an endogenous pyrogen
Tumor Necrosis Factor Alpha-could explain the 'wasting' slimness see in Africa

Front 133

TQ: where is the primary resevoir of infectious HIV?

Back 133

TQ: *in the lymph nodes* - where it's predominately found in the middle (chronic or latent phase) and they're mostly asymptomatic

Front 134

why is there such a considerable genomic diversity seen with HIV

Back 134

b/c of hypervariable regions of envelope glycoprotein- gradually changes HIV from M tropic to more T tropic agent

Front 135

TQ: in what stages is HIV most contagious?
~*in the chronic or latent phase, where does viral replication take place?*

Back 135

~in the early (acute) and final (crisis) stages. has highest viremia (detectable virus in the blood)
~*replication of virus is predominately in the lymphoid tissue*

Front 136

when is a person said to have AIDS

Back 136

when CD4+ counts are below 200

Front 137

what is Kaposi's sarcoma associated with?
what is it?

Back 137

~HIV - a rare skin cancer, might be cause by a separate infectious agent (HHV8 or Kaposi sarcoma HV)
~proliferation of endothelial cells lining lymph channels

Front 138

what is B cell lymphoma (non-Hodgkins) accociated with?

Back 138

~HIV- thought to be a comlication of Epstein-Barr infection

Front 139

TQ (matching):what is a common cause of death in early cases of HIV? (in about 60% of the cases)

Back 139

TQ: *Pneumocystis jiroveci (nee carinii) pneumonia (PCP)*

Front 140

TQ(matching): name of the systemic infection involving several organ systems in people with HIV?

Back 140

TQ: *toxoplasmosis*- causes encephalitis, responsible for half of mass lesions found in CNS

Front 141

TQ (matching):*most common fungal agent infecting AIDS patients
~(matching) *what causes chronic diarrhea in AIDS pts <1month

Back 141

TQ: *C. albicans or Candidiasis*
candidiasis- esophageal, tracheal or pulmonary
*cryptosporidiosis*

Front 142

TQ: can HSV-2 cause aseptic meningitis?

Back 142

TQ: yes, it's usually mild and self-limiting

Front 143

TQ: can HSV-2 cause aseptic meningitis?

Back 143

TQ: yes, it's usually mild and self-limiting

Front 144

TQ: what drugs can be used for Herpes viruses?

Back 144

TQ: chemotherapy drugs *Acyclovir* or Zovirax-for symptomatic relief only

Front 145

TQ: what is used to transcribe vRNA (of HIV) to cDNA?

Back 145

TQ: *enzymes: *reverse transcriptase
then the DNA is incorporated into the host's genome

Front 146

TQ: heterophile + and - both lead to what infectious disease?

Back 146

TQ: infectious mononucleosis

Front 147

TQ: ~*interstitial cell pneumonia* and *chorioretinitis* is associated with what virus
~chorioretinitis is it also known as?

Back 147

TQ: ~assoc with CMV mononucleosis
~AKA *pizza pie retinitis*
~the person may also have hepatitis, arthritis and carditis

Front 148

TQ: if a mother was infected with HSV-2 prior to her pregnancy, will the baby become infected?

Back 148

TQ: the greatest risk of infection at birth (intrapartum) is associated with active primary maternal infection {tricky Boss question, no clear answer, I think the baby won't be infected b/c at birth the mom would not still be in the active primary state}

Front 149

TQ: where is HEV commonly found?

Back 149

TQ: blood borne in *Asia, India, sub-Saharan Africa and Mexico*

Front 150

TQ: 80% of liver cancer among Asian Americans is due to...

Back 150

TQ: HBV

Front 151

TQ (matching): what three bacteria(?) are associated with AIDS and skin lesions?

Back 151

TQ: *Cryptococcosis, Histoplasmosis or Coccidioiodomycosis* - extrapulmonary and/or disseminated with skin lesions

Front 152

TQ (matching): in patients with AIDS, what age do you see disseminated *CMV*?

Back 152

TQ: >1 month old, commonly affects eyes (25% have chorioretinitis-pizza pie retinitis, 10% have GI lesions)

Front 153

TQ (matching):in patients with AIDS, what other virus might they have if they have persistent mucocutaneious ulcers or pulmonary infections?

Back 153

TQ: in patients >1month old with *HSV* and AIDS

Front 154

TQ (matching): leading cause of death worldwide among HIV + people

Back 154

TQ: ~TB
disseminated *mycobacteriosis*, cause by typical TB or atypical species (eg. MAI complex)

Front 155

TQ: many AIDS pts have neurological symptoms caused by what?

Back 155

TQ: ~*AIDS encephalopathy or dementia complex*
~gliosis of cerebral cortex, necrosis or gray and white matter, demyelination of white matter
~may involve inflammation b/c of infected monocytes and macrophages

Front 156

what's the treatment for people with HIV/AIDS?
what are the side effects

Back 156

~chemotherapy, a "cocktail" of AZT, ddi and protease inhibitors
reduces viral activity enough to be undetectable, increases T cell count
~neg. effects: diabetes, heart disease, vascular necrosis-->hip replacement

Front 157

do we have drugs to cure viral diseases?

Back 157

NO, we only have vaccines to prevent infection. drugs don't cure you once you have the virus

Front 158

signs of hepatitis (A-G)

Back 158

malaise, jaundice, fever, increased liver enzymes

Front 159

compare the Australia antigen and the Dane antigen

Back 159

Australia: on the surface of the virus
Dane: the complete virus, consists of 2 concentric layers

Front 160

which virus has oncogenic potential and is associated with cervical cancer?

Back 160

HSV-2, but doesn't neccessarily cause cervical cancer

Front 161

True or False: Epstein-Barr virus is largely asymptomatic in childhood.

Back 161

True

Front 162

what virus is associated with inguinal lymphodenopathy?
what virus is assoc w/ cervical lymphodenopathy?

Back 162

HSV-2 - inguinal
EBV - cervical

Front 163

True or False: Epstein-Barr virus targets Tcells.

Back 163

False: targets B cells

Front 164

what are the target sites of infective mononucleosis?

Back 164

B lymphocytes

Front 165

cytomegalovirus is shed for life in...

Back 165

breast milk, saliva, urine, semen

Front 166

most prevalent STI in the US

Back 166

HPV - Human Papilloma Virus

Front 167

what harbors HIV?

Back 167

lymphocytes (monocytes) and macrophages

Front 168

which virus is associated with herpes labialis

Back 168

HSV-1

Front 169

TQ: which virus is assoc. with pharyngeal erythema and edema

Back 169

TQ: HSV-1

Front 170

TQ:which virus is assoc with photophobia?

Back 170

TQ: HSV-2

Front 171

TQ: which virus is assoc with Burkitt's lymphoma?

Back 171

TQ: EBV

Front 172

which viruses are dsDNA?

Back 172

All herpes viruses: HSV-1 and 2, EBV, CMV, Varicella Zoster
HBV
HPV

Front 173

which virus is assoc with nasopharyngeal carcinoma

Back 173

EBV

Front 174

which herpes virus is spread sexually?

Back 174

HSV-2. the rest can be spread by kissing/saliva or mucus membranes

Front 175

which virus reporduces in the host cell nucleus?

Back 175

HSV-1

Front 176

which virus is assoc with gingivomastitis?

Back 176

HSV-1

Front 177

which virus is assoc with interstitial cell pneumonia?

Back 177

CMV

Front 178

which virus is assoc with keratoconjunctivitis?

Back 178

HSV-1

Front 179

which virus is assoc. with hepatosplenomegaly and jaundice?

Back 179

CMV

Front 180

95% of adults are seropositive for what virus?

Back 180

EBV

Front 181

which virus is associated with herpes neonatorum?

Back 181

HSV-2

Front 182

most common manisfestation of tertiary syphillis

Back 182

aortic aneurysm

Front 183

associated with condylomata lata

Back 183

syphilis (don't get confused with the condy--anogenital warts)

Front 184

TQ: world's leading cause of treatable blindness:

Back 184

TQ: *chlamydia-a chronic suppurative follicular keratoconjunctivitis*, lesions heal with scarring
{HSV-1 most common cause of corneal damage and blindness in industrialized world}

Front 185

causes genital elephantiasis, rectal strictures, acute epididymus, PID

Back 185

chlamydia- i didn't couldn't find acute epididymus but an old final review had this question twice
-gonorrhea also causes PID

Front 186

True or False: infective mononucleosis can be caused by the same virus as Burkitt's carcinoma

Back 186

true: EBV

Front 187

True or False: with infective mononucleosis the circulating cell that's infected is the T lymphocyte.

Back 187

False: B lymphocyte

Front 188

True or False: the microscopic changes in the liver in infective mononucleosis resemble viral hepatitis

Back 188

True

Front 189

True or False when regarding infective mononucleosis: exposure during childhood often results in asymptomatic infection

Back 189

True

Front 190

True or False: the microscopic changes in the lymph nodes in a pt with infective mononucleosis resemble Hodgekin's Disease

Back 190

False

Front 191

primary resevoir of this virus is in lymph nodes

Back 191

HIV/AIDS
~may also be found in monocytes and macrophages

Front 192

what is the hypothesis of why some people are not infected by HIV

Back 192

they lack CCR5 receptor
or if they are heterozygous- slows the onset of AIDS

Front 193

causative agents of Pelvic Inflammatory disease (PID)

Back 193

Neisseria gonorheoeae
Chlamydia trachomatis

Front 194

TQ: bacterial STI that's 'famous for having a short incubation time'
~*can it be spread by fomites?*

Back 194

TQ: gonorrhea: 2-7 days
*can be spread by fomites but it's rare*

Front 195

TQ: True or False: gonorrhea is* tissue type specific*

Back 195

True: hangs around mucosal surfaces lined by*transitional* or *columnar epithelium* (urethra, cervix, anal canal, throat, conjunctiva ) doesn't go into gonads

Front 196

what does this pertain to "attachment to microvilli by pili and multiplication evokes a chronic purulent inflammatory response"

Back 196

gonorrhea- neutrophils predominate
diagnosis: finding lots of phagocytosed diplococci in gram-stained smears of the exudate

Front 197

TQ: there's no protective immunity induced by gonorrhea and healing of gonorrhea involves scar, what's the importance?

Back 197

TQ: repeated infection may lead to extensive scarring/fibrosis
*ORCHITIS* (shouldn't it be no orchitis b/c it doesn't involve the testis)

Front 198

can scar tissue from gonorrhea impair fertility?

Back 198

yes; but it's functional sterility, doesn't involve testis

Front 199

what does salpingitis mean?
what's causes it?
what organs are not involved in women?

Back 199

~inflammed fallopian tubes- can progress and burst
~caused by gonorrhea
~doesn't involve uterus or ovaries

Front 200

TQ: ectopic pregnancy, bacteremia, endocarditis, arthritis, infertility and sterility can all be cause by...

Back 200

TQ: gonorrhea-->*PID pelvic inflammatory disease* *by Neisseria gonorrhea* and *Chlamydia trachomatis*

Front 201

how do you diagnose gonorrhea?

Back 201

men: smear
women (or if rectal or pharyngial infection): do a culture or lacroscopy

Front 202

TQ: what does chemoprophylactic eyedrops in newborns prevent?

Back 202

TQ: *conjunctival infection* *opthalmia neonatorum*- gonorrhea infection

Front 203

TQ: second most commonly reported STD

Back 203

TQ: *gonorrhea* (behind chlamydia)...herpes would be first but that's not reportable

Front 204

factors contributing to spread of gonorrhea:

Back 204

-human resevoirs can be asymptomatic
-penicillin resistant strains (absolute refractoriness PPNG strains (Penicillinase Producing N. gonorrhea)
-birth control pills-create salutary environment, b/c of horomone shift?

Front 205

how is trachoma transmitted?

Back 205

direct contact, fomites, and filth flies (mechanical vectors)
{chlamydia}

Front 206

TQ: most frequent form of chlamydial infection in US, *may be most common bacterial STI in the world*

Back 206

TQ: chlamydial urethritis or cervicitis
-also causes 50% of *non-gonococcal urethritis (NGU)*
-*chlamydia may be most common STI in world*

Front 207

compare the incubation time and duration of symptoms of gonorrhea and chlamydia

Back 207

chlamydia: incubation time is longer, symptoms more prolonged (and hidden)

Front 208

which STI is Teiter's syndrome the most severe complication in men

Back 208

chlamydia: genital infection, polyarthritis, conjunctivitis

Front 209

TQ: how can one acquire inclusion conjunctivitis?

Back 209

TQ: newborns from *mom with chlamydial cervicitis*. baby can also get neonatal pneumonia {inClusion ConjunCtivitis: Chlamydia Cervicitis}
adults: contaminations with genital secretions or unchlorinated pools

Front 210

TQ: what is primarily found in tropics:
*begins as genital ulcer*, granulomatous and suppurative (pus) -->inflammation of inguinal lymph nodes-->*bubos* that drain.
*genital elephantiasis*
but most resolve w/out treatment

Back 210

TQ: *lymphogranuloma venereum* : from chlamydia trachomatis

Front 211

TQ:~what STI is an intracellular parasite of columnar epithelial cells
~*does it resolve on it's own?*

Back 211

TQ: ~chlamydia
~*yes, self-limiting*

Front 212

TQ: which morphological form of chlamydia is the* infectious form*?
which is the *dividing form*?

Back 212

TQ: infectious: elementary body
dividing: reticulate body

Front 213

why is chlamydia rigid?
what does this mean it's resistant to?

Back 213

rigidity maintained by disulfide bonds so it's resistant to penicillin

Front 214

TQ: why is syphilis known as *'the great imposter'*
*what's the causative agent?*

Back 214

it's often misdiagnosed as something else, b/c it occurs in so many areas- in blood vessels
*causative agent: treponema pallidum*

Front 215

how is syphilis transmitted?

Back 215

most often by sexual intercourse, rarely transplacentally
it's never casually transmitted

Front 216

TQ: primarily an infectious of blood vessel walls

Back 216

TQ: syphilis: *inflammation of blood vessel endothelium, blocks lumen causing obliterative endarteritis which underlies all damage seen*
repair involves scarring and *fibrosis*

Front 217

TQ: chancres (primary lesion)
cause:
*when does it appear*
*how does it heal?*

Back 217

TQ:syphilis
only 30% of males and 50% of females have them, otherwise they'll move onto secondary phase
*appears b/t 10-90 days (avg 3 weeks)
*heals spontaneously, self-limiting*

Front 218

TQ: -*condylomata lata*-around moist areas
-macular skin rashes commonly involving palms and soles
-oral lesions that appear as white patches

Back 218

TQ: syphilis- *most infectious when chancres and condylomata latas are present* (*secondary phase*)

oral lesions look like candida

Front 219

in latent phase of syphilis, what might cause a chronic slowly developing damage

Back 219

an endotoxin and DH (i don't know what that is)

Front 220

TQ: *aortic aneurysm* and mesaortitis are associated with what stage of what STI

Back 220

TQ: *tertiary stage of syphilis
mesaortitis is the dialation of the media of the vessel -->weakening

Front 221

TQ: *neurosyphilis may present as...

affects which part of CNS

Back 221

chronic meningitis, tabes dorsalis or general paralysis
~affects posterior roots and columns of spinal cord, atrophy of brain

Front 222

TQ: *gumma is associated with what STI?
what does it resemble?

Back 222

TQ: ~*syphilitic gumma*- lesions of liver, bones, testis or skin with rubbery necrotic center
~resembles granulomas of TB

Front 223

can syphilis be transmitted transplacentally?

Back 223

yes- during second trimester

Front 224

characteristic triad of congenital syphilis

Back 224

1. interstitial keratits and choroiditis (saddle nose)
2. Hutchinson teeth (barrel incisors)
3. 8th cranial nerve deafness

Front 225

spirochete who's growth can be slowed by PPNG (penicillin producing N. gonorrhea).
associated with cocaine trafficking

Back 225

syphilis

Front 226

this STI is dropping to new lows in most places, except San Fran. LA and Seattle

Back 226

syphilis

Front 227

can non-syphlitic treponematoses be transmitted transplacentally?

Back 227

no

Front 228

TQ: *Yawa (frambesia): agent
~*what resembles Yaws and what does it look like?

Back 228

TQ: ~t. (pallidium) pertenue: Non-syphlitic treponematoses: *strawberry lesion* (initial lesion called *mother yaw* (framboise)*
~bejel (endemic syphilis) -*primary and secondary lesions in oral cavity*

Front 229

TQ: causative agent of *chancroid* (soft chancre)
what does it look like?
*where is it found in the world?*

Back 229

TQ: *haemophilus ducreyi* a bacteria
-red lesion, becomes pustular, ulcerates and has soft ragged edges,
*found in tropics and subtropics*

Front 230

treatment for chancroid

Back 230

antibiotics-clears all bacteria and lesions heal in 1-2 weeks

Front 231

TQ: STI that is a *protozoan, has *flagellates*

Back 231

TQ: *trichomoniasis : trichomonas vaginalis **it's eukaryotic**
irritates but doesn't penetrate mucosal surfaces

Front 232

TQ: *strawberry mucosa*
*seen in what stage only?*

Back 232

TQ: *trichomoniasis: small blisters on surfaces of urogenital tracts
*seen only in the trophozoites stage*

Front 233

TQ: heavy, greenish, thick, foul-smelling, foamy dishcarge in females
*typically asymptomatic in males*

Back 233

*trichomoniasis
*males are vectors* in this situation
{men are tricky: trich-omoniasis}

Front 234

what predisposes one to a symptomatic infection of trichomoniasis?

Back 234

loss of normal vaginal acidity (an increase of pH)

Front 235

TQ: *often coexists with gonorrhea

Back 235

TQ: *trichomoniasis

Front 236

Are these Gram + or -
staph aureus
clostridium
listeria

Back 236

gram +

Front 237

Are these gram + or -
E. coli
salmonella
shigella

Back 237

gram -

Front 238

TQ: incubation time for HCV

Back 238

TQ: 2-26 weeks (avg 6-12 weeks)

Front 239

TQ: most common enterics in US

Back 239

TQ: rotavirus, Norwalk virus and *E. coli*