Term
Which of the following is NOT a risk for transmission of blood-borne illness:
a. Tattooing
b. Hemodialysis
c. Sexual exposure
d. Exposure to clear urine of infected individual |
|
Definition
d. Exposure to clear urine of an infected individual
(Assuming there is no blood in it, which is what was meant by clear)
19-2 |
|
|
Term
| Blood is screened for presence of these 6 infectious agents. |
|
Definition
HIV-1
HIV-2
HBV
HCV
HTLV 1
Syphilis
19-2 |
|
|
Term
| Give an example of a surrogate marker for HBV infection. |
|
Definition
Serum liver enzymes (ALT)
19-2 |
|
|
Term
| What 4 viruses may cause hepatitis, but are not named as "hepatitis viruses?" |
|
Definition
Cytomegalovirus
Epstein-Barr virus
Yellow fever virus
Dengue virus
19-3 |
|
|
Term
| What two hepatitis viruses belong to the family Flavivirus? |
|
Definition
|
|
Term
"Hepatitis for 500."
This is the only Hepatitis virus that does not have an RNA genome. |
|
Definition
What is HBV? It is Incomplete dsDNA
19-3 |
|
|
Term
| What is the only hepatitis with an RNA genome that is anti-sense? |
|
Definition
|
|
Term
| These two drugs are used as therapy for HBV infection. |
|
Definition
|
|
Term
| These two drugs are used as therapy for HCV infection. |
|
Definition
|
|
Term
| What causes most of the damage in HBV infection? |
|
Definition
The immune system. (Immunopathogenesis)
19-5 |
|
|
Term
| Which DNA virus uses reverse transcriptase? |
|
Definition
|
|
Term
| What are the 4 important genes in Hepatitis B virus? |
|
Definition
Surface Ag (S)
Core (C)
pol (P)
X
19-4 |
|
|
Term
HBsAG may be found...
a. As free particles in serum
b. On the surface of HBV
c. Within the nucleocapsid of HBV
d. As polymers in serum
e. b and c
f. a,b, and d
g. all of the above |
|
Definition
f
As free particles in the serum
As polymers in the serum
On the surface of HBV
19-4 |
|
|
Term
| If you do not clear HBV after infection, what is the probability of you presenting with chronic hepatitis? |
|
Definition
|
|
Term
| What proportion of people with persistent HBsAG positive results will continue to be asymptomatic? |
|
Definition
|
|
Term
"Hepatitis for 400"
This molecule may be associated with infectivity of HBV. |
|
Definition
What is HBeAg?
It is a sign of ongoing HBV replication and higher viral load.
19-7 |
|
|
Term
| Name the antibody the provides immunity to HBV. |
|
Definition
|
|
Term
| Name the first antibody to appear in a person with HBV infection. |
|
Definition
|
|
Term
X protein in HBV:
a. Increases attachment to cells
b. Inhibits the action of interferon gamma
c. Transcriptional activator
d. Associated with lower hepatocellular carcinoma risk |
|
Definition
c. Transcriptional activator
It is associated with higher hepatocellular carcinoma risk
19-7 |
|
|
Term
| Name the general situation where you would use HBIG. |
|
Definition
Unvaccinated exposed individuals (along with vaccine)
This includes newborns to affected mothers.
19-8 |
|
|
Term
| Name 4 drugs used for chronic HBV infection. |
|
Definition
Alpha interferon
Lamivudine
Adefovir dipivoxil
Entecavir
19-8 |
|
|
Term
Which of the following drugs has problems with resistance in HBV:
a. alpha interferon
b. Lamivudine
c. Adefovir
d. Entecavir |
|
Definition
b. Lamivudine
Resistance is a problem due to mutations in viral polymerase (reverse transcriptase)
19-8 |
|
|
Term
| Name two groups who are at higher risk for HDV co-infection with HBV. |
|
Definition
Hemophiliacs
IV drug users
19-8 |
|
|
Term
| What lab test can diagnose HDV infection? |
|
Definition
Serology for Anti-delta Ag
19-8 |
|
|
Term
| What 2 agents are used to HCV? |
|
Definition
alpha-interferon
Ribivirin
19-9 |
|
|
Term
| If a patient may be in the window period of HCV, having just stuck themselves with a needle from an affected person, how could you test them to know without waiting for serology to become positive? |
|
Definition
RT-PCR for presence of circulating virus
19-9 |
|
|
Term
| What proportion of transplants for chronic HBV or HCV infections are associated with re-infection of new liver due to the same agents (patient manifesting same virus as indicated the transplant)? |
|
Definition
Virtually all of them
19-10 |
|
|
Term
| Reactivation of these 4 pathogens is a concern in transplants. |
|
Definition
| HSV
HBV
HCV
Trypanosoma cruzi
19-10 |
|
|
Term
Which is more severe:
a. Primary HSV infection in transplant patient
b. Reactivation of latent HSV infection in transplant patient |
|
Definition
a. First time infection of HSV
19-10 |
|
|
Term
EBV infects B cells via the receptor:
a. BCR
b. CD19
c. CD21
d. zeta chain |
|
Definition
c. CD21 or complement receptor CR2
19-11 |
|
|
Term
| Name 4 cancer's that EBV is associated with |
|
Definition
Burkitt's lymphoma
Nasopharyngeal carcinoma
non-Hodgkin's lymphoma (most)
Hodgkin's lymphoma (some)
19-11 |
|
|
Term
What is the largest risk in EBV infection in patients with a transplant under immunosuppression?
a. Hodgkin's lymphoma
b. PTLD
c. Autoimmune disease |
|
Definition
|
|
Term
| Name the one antigen made by EBV that cannot be processed and presented by MHC-I. |
|
Definition
|
|
Term
| Two agents that are effective against EBV during the replicative cycle. |
|
Definition
Acyclovir
Gancyclovir
19-12 |
|
|
Term
You are treating a patient with Hepatitis B, Hepatitis C, and HIV. You use a needle to inject him with some drugs. Then, as you turn around to place the needle in the sharps container, an evil ninja emerges from the shadows! Years of medical school training have honed your reflexes, and you fling the needle like a dart; it sticks him in the arm.
Frightened, he flees like the coward he is, but you take comfort in the fact that he might catch all those diseases. What are the ninja's chances of catching Hep B, Hep C, and/or HIV from the needlestick injury? |
|
Definition
Hep B: ~30%
Hep C: ~3%
HIV: ~0.3%
(Syllabus: 19-2) |
|
|
Term
Hepatitis comes in six delicious flavors: A, B, C, D, E, and G. Which of them can be transmitted parenterally?
FOR ONE BONUS POINT: How are the others transmitted? |
|
Definition
Hep B, C, D, and G can be transmitted parenterally.
Hep A and E use the fecal-oral route.
(Syllabus: 19-3) |
|
|
Term
| Which hepatitis viruses can cause chronic liver infection? |
|
Definition
| Hepatitis B, C, and D can cause chronic liver infection (which, by the way, can progress to liver cancer). |
|
|
Term
| Ugh, I don't want hepatitis! I'll get every vaccine available. Doing so will protect me against which types of Hepatitis? |
|
Definition
A, B, and D.
(Syllabus: 19-3) |
|
|
Term
Hepatitis B is a member of the Hepadnavirus family. What else is true about it?
A) It has single-stranded DNA.
B) It has double-stranded DNA.
C) It has single-stranded RNA.
D) It has double-stranded RNA. |
|
Definition
B. It has double-stranded DNA.
(Syllabus: 19-4) |
|
|
Term
TRUE OR FALSE:
Hepatitis B has reverse transcriptase. |
|
Definition
|
|
Term
An evil ninja comes to see you in your office, wondering if he has Hepatitis B. You request a serology test and get the following results:
HBV DNA: Positive
HBeAg: Positive
HBsAg: Positive
Anti-HBcAg: Negative
Anti-HBsAg: Negative
What do you tell the ninja? |
|
Definition
You can tell him whatever you want, but the fact is that he has acute Hepatitis B (currently in its "window period," though that doesn't matter with modern tests).
(Syllabus 19-7) |
|
|
Term
"I'll take Hepatitis for 300, Alex."
"And the answer is:
THIS virus exacerbates Hepatitis B infections." |
|
Definition
"What is Hepatitis D?"
(Syllabus: 19-8) |
|
|
Term
| To what family of viruses does Hepatitis C belong, and what kind of nucleic acid does it have? |
|
Definition
It is in the flavivirus family, and it has positive-sense RNA.
(Mnemonic: You get a child to try a food and she likes it. You say, "SEE, you like the FLAVor! Wasn't this a POSITIVE experience?")
(Syllabus: 19-9)
|
|
|
Term
| What unpleasant results might you experience if you have a chronic infection with Epstein-Barr virus? |
|
Definition
Some cancers: Nasopharyngeal carcinoma and various lymphomas ("Burkitt's," as well as both Hodgkin's and non-Hodgkin's).
Also, if you need a transplant, you might get post-transplant lymphoproliferative disease (PTLD).
(Syllabus: 19-11) |
|
|
Term
Epstein-Barr virus is a:
A) DNA virus
B) RNA virus
C) Computer virus
D) All of the above
E) None of the above
F) Some of the above |
|
Definition
A. It's a DNA virus.
(Syllabus: 19-11) |
|
|
Term
| Your transplant patient gets PTLD from an Epstein-Barr infection that was latent in his donated organ. He asks, "Medical Student, what the heck is PTLD? And what can you do to treat me?" |
|
Definition
PTLD is post-transplant lymphoproliferative disease. The virus was latent in the organ's B cells, but when he became immunocompromised, it triggered a proliferative growth program in those B cells. It could progress to lymphoma.
The best thing to do is reduce the immunosuppressive therapy. You might also give him IV immunoglobulins. There aren't a lot of other options.
Ideally, you wouldn't have put an EBV-positive organ into an EBV-negative recipient in the first place.
(Syllabus: 19-12) |
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