Path 8b Flashcards

What pathogen is higher risk in unvaccinated individuals and presents with cough, runny nose, conjunctivitis, a diffuse rash, and blue-white spots in the mouth?

A. Mumps

B. Measles

C. Poliovirus

D. West Nile virus

Which measles receptor normally helps inactivate C3 convertase?

A. CD155

B. CCR5

C. CD46

D. SLAM

What signaling receptor is implicated in the pathogenesis of measles?

A. Nectin-4

B. CD46

C. CCR5

D. SLAM

What signaling receptor is responsible for viral replication for measles?

A. Nectin-4

B. CD155

C. CD46

D. CCR5

Why can measles cause substantial morbidity and mortality?

A. Persistent bacteremia

B. Profound transient immunosuppression

C. Chronic vascular thrombosis

D. Permanent complement activation

What rare central nervous system sequelae of measles infection occurs a few days following the developement of the classic rash?

______

Which oral finding is pathognomonic for measles?

A. Aphthous ulcers

B. Koplik spots

C. Gingival plaques

D. Palatal vesicles

Koplik spots are typically found near the opening of which duct?

A. Wharton duct

B. Stensen duct

C. Lacrimal duct

D. Cystic duct

Which description best matches Koplik spots?

A. Ulcerated mucosal lesions

B. Vesicular skin lesions

C. Necrotic lymphoid plaques

D. Hemorrhagic oral nodules

A lymph node biopsy from a measles patient shows multinucleated giant cells. What are these called?

A. Reed-Sternberg cells

B. Warthin-Finkeldey cells

C. Langhans giant cells

D. Touton giant cells

Warthin-Finkeldey cells may be found in which site?

A. Lymphoid organs

B. Renal glomeruli

C. Salivary ducts

D. Peripheral nerves

Which additional site may contain Warthin-Finkeldey cells?

A. Pancreatic ducts

B. Lungs

C. Myocardium

D. Bone marrow

Which respiratory specimen may contain Warthin-Finkeldey cells?

A. Pleural fluid

B. Sputum

C. Nasal mucus

D. Bronchial lavage

A patient has an acute systemic viral illness with painful swelling of salivary glands. Which diagnosis is most likely?

A. Measles

B. Mumps

C. Poliovirus

D. West Nile virus

Which two surface glycoproteins are found on mumps virus?

A. Hemagglutinin and neuraminidase

B. CD46 and nectin-4

C. SLAM and CD155

D. CCR5 and CD46

Which mumps glycoprotein pair resembles influenza surface proteins?

A. CD46 and SLAM

B. Hemagglutinin and neuraminidase

C. Nectin-4 and CD155

D. CCR5 and CD46

What is the most common extrasalivary complication of mumps?

A. Orchitis

B. Pancreatitis

C. Aseptic meningitis

D. Encephalitis

Mumps is most likely in a child who presents with ______ pain and enlarged ______ glands.

What are the symptoms of mumps?

______
______
______ meningitis
______

Inflammation of the testes from mumps is called:

A. Nephritis

B. Orchitis

C. Uveitis

D. Myelitis

Which system is commonly involved when mumps spreads extrasalivarily?

A. CNS

B. PNS

C. Endocrine system

D. Lymphatic system

Mumps involvement of the CNS may manifest as:

A. Encephalitis

B. Myocarditis

C. Nephritis

D. Vasculitis

What possible sequela can occur in mumps, especially after puberty?

_____

A patient develops an acute systemic viral illness ranging from mild symptoms to paralysis of limb and respiratory muscles. Which virus is most likely?

A. Measles virus

B. Mumps virus

C. Poliovirus

D. West Nile virus

Severe poliovirus infection may paralyze which muscles?

A. Limb muscles

B. Facial muscles

C. Extraocular muscles

D. Cardiac muscle

Which additional muscle group may be paralyzed in severe poliovirus infection?

A. Respiratory muscles

B. Smooth muscle

C. Esophageal muscles

D. Pupillary muscles

Which receptor does poliovirus bind to enter human cells?

A. CD46

B. CD155

C. SLAM

D. CCR5

Poliovirus is higher risk in ______ individuals and presents with ______, ______, and ______.

What two vaccines can be used for poliovirus infections?

_____ vaccine (injection)

_____ vaccine (by mouth)

B-cell immunodeficiency results in predisposition to which two type of viruses?

______

______ encephalitis

A patient has fever, headache, myalgia, fatigue, anorexia, and nausea from a systemic viral infection. Which diagnosis best fits?

A. West Nile virus

B. Measles

C. Mumps

D. Poliovirus

Approximately what proportion of West Nile infections are asymptomatic?

A. 20%

B. 40%

C. 60%

D. 80%

Before reaching lymph nodes, West Nile virus initially replicates in which cells?

A. Skin dendritic cells

B. B lymphocytes

C. Motor neurons

D. Endothelial cells

After replicating in skin dendritic cells, West Nile virus next spreads to:

A. Lymph nodes

B. Salivary glands

C. Renal tubules

D. Bone marrow

Which receptor has an unusual protective role against neuroinvasive West Nile infection?

A. CD155

B. CCR5

C. CD46

D. SLAM

Functional CCR5 has what effect on West Nile infection?

A. Increases paralysis

B. Confers neuroinvasive resistance

C. Causes immunosuppression

D. Promotes viral latency

Loss-of-function mutations in both CCR5 copies increase risk of:

A. Symptomatic West Nile infection

B. Severe measles immunosuppression

C. Mumps orchitis

D. Poliovirus paralysis

What condition is caused by West Nile virus?

_______

How does CCR5 loss affect HIV compared with West Nile virus?

A. Protective in both infections

B. Harmful in both infections

C. Protective HIV, harmful West Nile

D. Harmful HIV, protective West Nile

Why is CCR5 loss protective against HIV?

A. HIV uses CCR5 entry

B. CCR5 activates caspases

C. CCR5 blocks complement

D. HIV binds CD155

A patient develops shock during a severe viral multisystem illness caused by vascular dysregulation and damage. Which syndrome best fits?

A. Viral hemorrhagic fever

B. Acute measles

C. Poliomyelitis

D. Chronic GVHD

Which tissue is commonly damaged across viral hemorrhagic fevers?

A. Blood vessels

B. Salivary glands

C. Renal tubules

D. Peripheral nerves

Viral hemorrhagic fever can damage vessels directly by infecting which cells?

A. Endothelial cells

B. Plasma cells

C. Motor neurons

D. Hepatocytes

Viral hemorrhagic fever may indirectly damage vessels through cytokines released by:

A. Leukocytes

B. Erythrocytes

C. Platelets

D. Fibroblasts

Leukocyte cytokine release in viral hemorrhagic fever promotes what process?

A. Inflammation

B. Paralysis

C. Latency

D. Opsonization

Severe vascular damage in viral hemorrhagic fever may ultimately cause:

A. Shock

B. Orchitis

C. Dysphagia

D. Meningitis

Which viral family most commonly establishes latency in humans?

A. Herpesviruses

B. Paramyxoviruses

C. Picornaviruses

D. Flaviviruses

HSV-infected cells contain large pink-purple intranuclear inclusions called:

A. Downey cells

B. Cowdry bodies

C. Owl-eye cells

D. Reed-Sternberg cells

CMV belongs to which herpesvirus subgroup?

A. Alpha

B. Beta

C. Gamma

D. Delta

An “owl’s-eye” inclusion is classically associated with:

A. HSV

B. EBV

C. CMV

D. Measles

CMV infection can transiently cause which immune effect?

A. Severe immunosuppression

B. Permanent neutropenia

C. Excess antibody production

D. Complement hyperactivation

Which groups are most concerning for severe CMV disease?

A. Children and athletes

B. Neonates and immunocompromised

C. Elderly and smokers

D. Adults and adolescents

Signs and Symptoms in Newborns

• Yellow skin and eyes (jaundice)
• Enlarged liver and spleen
• Small head size (microcephaly)
• Tiny purple or red spots on the skin (petechiae)
• Seizes or developmental delays

A. EBV mononucleosis

B. Cytomegalic inclusion disease

C. HSV encephalitis

D. Measles infection

Which test can distinguish cytomegalic inclusion disease from erythroblastosis fetalis?

A. Monospot test

B. PCR testing

C. Coombs test

D. ANA testing

Which additional method can confirm cytomegalic inclusion disease?

A. Viral culture

B. Heterophile testing

C. Flow cytometry

D. Indirect immunofluorescence

An immunocompetent adult with CMV most commonly develops what syndrome?

A. Pneumonia-like illness

B. Mononucleosis-like illness

C. Hemorrhagic fever

D. Paralytic illness

Which symptom commonly occurs in immunocompetent CMV infection?

A. Fever

B. Orchitis

C. Paralysis

D. Hemorrhage

Which hematologic finding may accompany immunocompetent CMV infection?

A. Neutropenia

B. Lymphocytosis

C. Thrombocytosis

D. Eosinophilia

Which lymphatic finding may occur with immunocompetent CMV infection?

A. Splenic rupture

B. Lymphadenopathy

C. Thymic atrophy

D. Marrow fibrosis

Which organ enlargement may occur in immunocompetent CMV infection?

A. Splenomegaly

B. Cardiomegaly

C. Hepatomegaly

D. Nephromegaly

An immunocompromised patient with CMV develops visual symptoms. Which manifestation is most likely?

A. Chorioretinitis

B. Keratitis

C. Optic neuritis

D. Cataracts

What constellation of findings is seen in patients with congenital cytomegalovirus infection?

_____ loss
s_____
c_____
_____ muffin rash
_____ rash
_____ calcifications

Which pulmonary manifestation can CMV cause in immunocompromised patients?

A. Bronchiectasis

B. Pneumonitis

C. Emphysema

D. Pneumothorax

An immunocompromised patient develops CMV-associated diarrhea and abdominal pain. Which manifestation is likely?

A. Colitis

B. Pancreatitis

C. Hepatitis

D. Appendicitis

A CBC from an EBV patient shows unusual mononuclear cells. What are they?

A. Atypical T lymphocytes

B. Plasma cells

C. Immature neutrophils

D. Eosinophilic blasts

Atypical lymphocytes seen in EBV mononucleosis are also called:

A. Cowdry cells

B. Downey cells

C. Owl-eye cells

D. Langerhans cells

What is the main cellular reservoir for EBV?

A. T cells

B. B cells

C. Neutrophils

D. Monocytes

In the “Mono HELPS” mnemonic, the “M” represents:

A. Myocarditis

B. Meningitis

C. Myositis

D. Mastitis

In “Mono HELPS,” the “H” represents:

A. Hepatitis

B. Hemolysis

C. Hypersensitivity

D. Hemorrhage

In “Mono HELPS,” the “E” represents:

A. Endocarditis

B. Encephalitis

C. Enteritis

D. Epididymitis

In “Mono HELPS,” the “L” represents:

A. Leukopenia

B. Lymphadenitis

C. Laryngitis

D. Lymphoma

In “Mono HELPS,” the “P” represents:

A. Pneumonitis

B. Pancreatitis

C. Pericarditis

D. Pyelonephritis

In “Mono HELPS,” the “S” represents:

A. Sepsis

B. Splenitis

C. Synovitis

D. Sinusitis

Which EBV protein binds viral DNA to host chromosomes?

A. LMP1

B. EBNA1

C. vIL-10

D. CD40

What is a key function of EBNA1?

A. Activates complement

B. Ensures equal viral division

C. Suppresses antibody secretion

D. Destroys infected B cells

EBNA1 helps EBV genomes segregate into:

A. Daughter cells

B. Neutrophil granules

C. Plasma proteins

D. Viral envelopes

Which EBV protein drives B-cell activation?

A. EBNA1

B. LMP1

C. vIL-10

D. CD16

LMP1 activates B cells by mimicking which host signal?

A. CD28

B. CD40

C. CD16

D. CD25

Which EBV protein suppresses the host immune response?

A. LMP1

B. EBNA1

C. vIL-10

D. CD40

Which T-cell population contributes to EBV atypical lymphocytes?

A. CD4 T cells

B. CD8 T cells

C. Tfh cells

D. Th17 cells

Which innate lymphocyte also contributes to EBV atypical lymphocytes?

A. CD16 NK cells

B. Plasma cells

C. Basophils

D. Eosinophils

The CD8 T cells seen in EBV atypical lymphocytosis are directed against:

A. CMV

B. EBV

C. HSV

D. Measles

A patient with prior EBV infection develops a t(8;14) MYC translocation. Which malignancy is associated?

A. Hodgkin lymphoma

B. Burkitt lymphoma

C. Multiple myeloma

D. Follicular lymphoma

In Burkitt lymphoma, where do lesions occur in different epidemiological forms?

_____ lesions in the endemic form in Africa

_____ and/or _____ lesions in the sporadic form

How is the histologic appearance of Burkitt lymphoma, as shown in the image, described?

What population age is associated with Burkitt lymphoma?

_______ and _______ adults

Which oncogene is involved in the EBV-associated t(8;14) translocation?

A. BCL2

B. MYC

C. RAS

D. TP53

Which screening test supports a diagnosis of EBV mononucleosis?

A. Monospot test

B. Coombs test

C. ANA test

D. PCR only

The Monospot test detects which type of antibody reaction?

A. Antinuclear antibody

B. Heterophile antibody

C. Antiphospholipid antibody

D. Anti-histone antibody

Which serologic trend supports recent EBV infection?

A. Falling ANA titers

B. Rising EBV antibodies

C. Falling IgE levels

D. Rising C4d levels

Which combination best supports an EBV diagnosis?

A. Atypical lymphocytes, Monospot, rising antibodies

B. Owl-eye cells, PCR, neutropenia

C. Cowdry bodies, culture, rash

D. CD155 binding, paralysis, meningitis

Which herpesvirus group infects epithelium and establishes neuronal latency?

A. Alpha herpesviruses

B. Beta herpesviruses

C. Gamma herpesviruses

D. Retroviruses

Which viruses belong to the alpha-herpesvirus group?

A. CMV, HHV-6, HHV-7

B. EBV, HHV-8, CMV

C. HSV-1, HSV-2, VZV

D. HSV-1, EBV, CMV

Alpha herpesviruses characteristically establish latency in which cells?

A. Hepatocytes

B. Neurons

C. Lymphocytes

D. Endothelial cells

Which tissue is initially infected by alpha herpesviruses?

A. Epithelium

B. Lymphoid tissue

C. Bone marrow

D. Renal tubules

Which herpesvirus group infects lymphocytes and can remain latent in several cell types?

A. Alpha group

B. Gamma group

C. Beta group

D. Retrovirus group

Which viruses belong to the beta-herpesvirus group?

A. CMV, HHV-6, HHV-7

B. HSV-1, HSV-2, VZV

C. EBV, HHV-8, HSV-1

D. VZV, EBV, CMV

Beta herpesviruses characteristically infect which cells?

________

Unlike alpha herpesviruses, beta herpesviruses may remain latent in:

A. Neurons exclusively

B. Lymphoid cells exclusively

C. Various cell types

D. Epithelial cells exclusively

Which herpesvirus group establishes latency primarily in lymphoid cells?

A. Beta herpesviruses

B. Alpha herpesviruses

C. Gamma herpesviruses

D. Orthomyxoviruses

Which viruses belong to the gamma-herpesvirus group?

A. HSV-1 and HSV-2

B. EBV and HHV-8

C. CMV and HHV-6

D. VZV and CMV

What are the physical findings of Kaposi sarcoma associated with HHV-8 infection with a CD4⁺ count < 500 cells/mm³?

Invading _____ _____ cells that form _____ tumors visible on histology

Which oncogenic virus is associated with Kaposi sarcoma?

A Chinese male with prior EBV infection develops a malignancy. Which cancer is classically associated?

A. Gastric cancer

B. Burkitt lymphoma

C. Nasopharyngeal carcinoma

D. Hepatocellular carcinoma

An African patient with prior EBV infection develops lymphoma. Which malignancy is associated?

A. Hodgkin lymphoma

B. Burkitt lymphoma

C. Follicular lymphoma

D. Mantle cell lymphoma

Which gastrointestinal malignancy is associated with EBV?

A. Colon cancer

B. Pancreatic cancer

C. Gastric cancer

D. Esophageal cancer

Which group contains three malignancies associated with EBV?

A. Burkitt, gastric, nasopharyngeal cancers

B. Colon, thyroid, hepatic cancers

C. Pancreatic, renal, bladder cancers

D. Melanoma, glioma, sarcoma

An HIV-positive patient develops a white oral lesion associated with EBV. What is the diagnosis?

A. Oral candidiasis

B. Aphthous ulcer

C. Oral hairy leukoplakia

D. Kaposi sarcoma

Which virus causes sixth disease?

A. HHV-6

B. HHV-8

C. HSV-1

D. CMV

How does the rash seen in roseola infantum spread automatically?

Starts on the _____ and then spreads to the _____

Roseola infantum is another name for infection with:

A. EBV

B. HSV-2

C. HHV-6

D. VZV

HHV-6 belongs to which herpesvirus subgroup?

A. Alpha

B. Beta

C. Gamma

D. Delta

Which three names refer to the same illness?

A. Roseola, sixth disease, exanthem subitum

B. Mumps, roseola, exanthem subitum

C. Measles, sixth disease, rubella

D. Varicella, roseola, shingles

Which virus is a major cause of corneal blindness?

A. HSV-1

B. HSV-2

C. CMV

D. HHV-6

Which virus is a major cause of fatal sporadic encephalitis?

A. VZV

B. EBV

C. HSV-1

D. HSV-2

A patient develops gingivostomatitis and recurrent facial cold sores. Which virus is most likely?

A. HSV-2

B. HSV-1

C. CMV

D. HHV-6

A patient develops recurrent painful genital vesicles. Which virus is most likely?

A. HSV-1

B. VZV

C. HSV-2

D. CMV

Which neurologic complication is associated with HSV-2?

A. Fatal sporadic encephalitis

B. Aseptic meningitis

C. Corneal blindness

D. Peripheral neuropathy

Which clinical combination best matches HSV-2?

A. Cold sores and encephalitis

B. Genital herpes and meningitis

C. Roseola and lymphadenopathy

D. Gastric cancer and leukoplakia

HSV-1 remains latent in which structure?

A. Sacral ganglia

B. Trigeminal ganglia

C. Dorsal root

D. Celiac ganglia

How can you differentiate esophageal ulcers caused by HSV-1 from those caused by cytomegalovirus?

HSV-1 causes _____- _____ ulcers

Cytomegalovirus causes _____ ulcers

What brain lesion causes sudden hyperoral, hypersexual, and uninhibited behavior with a positive cerebrospinal fluid polymerase chain reaction for HSV-1?

Bilateral _____ lesions

What viral infections are associated with intranuclear eosinophilic Cowdry A inclusions?

_______

_______

_______

HSV-2 remains latent primarily in which structure?

A. Trigeminal ganglia

B. Cervical ganglia

C. Sacral ganglia

D. Sympathetic chain

Which diagnostic test for HSV can reveal multinucleated giant cells?

A. PCR

B. Tzanck smear

C. Monospot

D. Viral culture

Which molecular test can diagnose HSV infection?

A. PCR

B. ANA

C. Monospot

D. Coombs test

Which pair represents diagnostic methods for HSV?

A. Tzanck smear and PCR

B. Monospot and ANA

C. Culture and Coombs test

D. C4d and RF

Which pair is listed for HSV-1 and HSV-2 treatment?

A. Acyclovir and valacyclovir

B. Acyclovir and cefazolin

C. Valacyclovir and gentamicin

D. Famciclovir and aztreonam

What is the advantage of using valacyclovir over acyclovir?

Valacyclovir is a prodrug of acyclovir with better ______ bioavailability

Which medication is listed as a treatment for CMV?

A. Acyclovir

B. Tacrolimus

C. Neomycin

D. Cefuroxime

Which additional drug is listed for CMV treatment?

A. Spectinomycin

B. Valacyclovir

C. Gentamicin

D. Penicillin V

Which third medication is listed for CMV treatment?

A. Famciclovir

B. Cefotaxime

C. Tobramycin

D. Vancomycin

A herpesvirus infects epithelium before establishing neuronal latency. Which virus could fit?

A. CMV

B. EBV

C. HSV-1

D. HHV-6

A herpesvirus establishes latency in lymphoid cells and is associated with several malignancies. Which virus best fits?

A. HSV-2

B. EBV

C. VZV

D. HHV-6

A herpesvirus belongs to the beta group and causes roseola. Which virus is it?

A. HHV-6

B. HHV-8

C. HSV-1

D. EBV

Measles can be diagnosed via ______ or by ______ and ______ secretions

Viral hemorrhagic fever is caused by viruses with which structural feature according to these notes?

A. Encapsulated

B. Nonencapsulated

C. Segmented

D. Double-stranded

Which set contains only viral hemorrhagic fever families?

A. Herpes, adeno, reo, retro

B. Arena, filo, bunya, flavi

C. Paramyxo, orthomyxo, picorna, corona

D. Papilloma, polyoma, calici, hepe

A pregnant woman contracts Zika virus. Which fetal abnormality is classically associated?

A. Hydrocephalus

B. Macrocephaly

C. Microcephaly

D. Spina bifida

Which mosquito genus transmits Zika virus?

A. Anopheles

B. Culex

C. Sandfly

D. Aedes

A newborn exposed to Zika in utero undergoes brain imaging. Which finding is expected?

A. Cerebral calcifications

B. Subdural hematoma

C. Cerebral aneurysms

D. Epidural hemorrhage

Why can congenital Zika infection produce cerebral calcifications?

A. It infects hepatocytes

B. It grows in neurons

C. It destroys erythrocytes

D. It infects osteoclasts

Which group contains cutaneous manifestations of HSV-1 or HSV-2 infection?

A. Shingles, roseola, warts

B. Molluscum, shingles, measles

C. Genital herpes, gingivostomatitis, cold sores

D. Varicella, zoster, erythema multiforme

Where does varicella-zoster virus classically remain latent?

A. Anterior horn cells

B. Sympathetic ganglia

C. Cerebellar nuclei

D. Dorsal root ganglia

Reactivation of VZV from the geniculate nucleus produces which syndrome?

A. Ramsay-Hunt syndrome

B. Horner syndrome

C. Lambert-Eaton syndrome

D. Guillain-Barré syndrome

A patient develops shingles from VZV latent in the geniculate nucleus. Which neurologic finding may occur?

A. Limb paralysis

B. Facial paralysis

C. Diaphragmatic paralysis

D. Tongue paralysis

Besides dorsal root ganglia, VZV may remain latent in ganglia associated with which cranial nerve?

A. Facial nerve

B. Vagus nerve

C. Trigeminal nerve

D. Hypoglossal nerve

Localized VZV recurrence is especially frequent and painful in dermatomes innervated by which ganglia?

A. Ciliary ganglia

B. Otic ganglia

C. Geniculate ganglia

D. Trigeminal ganglia

CMV establishes latent infection primarily in which cells?

A. Monocytes

B. Neutrophils

C. Erythrocytes

D. Platelets

Initial replication of West Nile virus occurs in which cells?

A. Alveolar macrophages

B. Hepatic Kupffer cells

C. Skin dendritic cells

D. Intestinal epithelial cells