Micro Exam #5 1998 - UNIVERSITY OF LOUISVILLE SCHOOLVOF...

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Unformatted text preview: UNIVERSITY OF LOUISVILLE SCHOOLVOF MEDICINE DEPARTMENT OF MICROBIOLOGY AND IMMUNOLOGY Medical Microbiology and Immunology EXAM V Monday, November 23, 1998 PLEASE CHOOSE THE SINGLE BEST ANSWER FOR EACH QUESTION #1—66: 1. All of the following are characteristic of rhinoviruses, EXCEPT: A. acid-lability B. optimal replication at 330 C versus 37° C C. transmission by respiratory route rather than fecalpral route D. peak incidence of human infections in fall and spring [E3 two human serotypes, known as A and B CJ 2. Which of the following laboratory assays is routinely used in the US. to determine the “virus load” in HIV—infected individuals, in order to monitor the effectiveness of combination anti— retroviral therapy ? (Al. RT-PCR of viral RNA in serum or plasma B. PCR of proviral DNA in peripheral blood mononuclear cells C. flow cytometry of peripheral blood mononuclear cells to determine ratio of CD4+ versus CD8+ T cells D. E. enzymatic assay to quantitate “reverse transcriptase” activity in serum antibody-capture ELISA to quantitate serum antibody to recombinant p24Gag antigen /, 3. Enterovirus 70 and coxsackie A24 virus are the major causes of this clinical syndrome in adults and children, with an outbreak of over 1,000 cases recently reported from St. Croix after Hurricane George struck the US. Virgin Islands on September 21, 1998: keratoconjunctivitis chorioretinitis acute hemorrhagic conjunctivitis pharyngoconjunctival fever gastroenteritis The following set of ten answers (A—J, listed in alphabetical order) are to be used in answering questions #48. Answers can be used once, more than once. or not at all. A. aseptic meningitis F. Reye’s syndrome B. Guillain—Barré syndrome G. sporadic necrotizing encephalitis C. paralysis, acute flaccid H. subacute sclerosng panencephalitis (SSPE) D. postinfectious encephalomyelitis I. subacute spongiform encephalopathy E. progressive multifocal leuko— J. tropical spastic paraparesis (TSP) encephalopathy (PML) 4. In approximately one out of every million cases of measles. a rare degenerative disease of the i : central nervous system developed several years later. What is this rare, measles virus- associated CNS disease ? 5. This clinical syndrome, which involves both the brain and the liver, is epidemiologically associated with influenza (especially type B) and varicella in children, but is most likely caused by the consumption of aspirin (salicylate): 6. The incidence of this neurological syndrome in adults has increased with the AIDS epidemic, because the syndrome is associated with immunosuppresSim/immunodeficiency and reactivation of a human papovavirus other than HPV: 7. This rare disease can occur in elderly persons in a sporadic form that does not result from exposure to an infectious agent, but may also be transmitted accidently in an infectious form from humans or animals with this disease: 8. This neurological syndrome is caused by HTLV«I, the same virus which is responsible for “adult T—cell leukemia:” IX) 10. ll. According to the recommendations of the AClP published by the CDC. all of the following are target groups for annual immunization with the influenza vaccine EXCEPT: A. persons 2 65 years of age B. adults and children with chronic disorders of the pulmonary or cardiovascular systems C/ healthy young adults who are participating in intercollegiate athletics D. physicians. nurses and other health care personnel in hospitals and out-patient care facilities pregnant females who will be in the second or third trimester of pregnancy during the influenza season F“ If an adult or adolescent is infected with HIV-1 during sexual activity with an HIV—infected person, what is the approximate “incubation period" for development of AIDS, assuming the newly infected person is not diagnosed with HIV‘infection prior to developing AIDS ‘? A. 1 month B. 3 months C. 1 year / 3 years i 10 years A new class of anti-HIV drugs targets a different enzymatic activity than that of currently licensed anti-HIV drugs , but these new drugs have not yet been shown to be highly effective in humans and have therefore not yet been licensed. What HlV~specific enzymatic activity is targeted by these new, unlicensed drugs ? viral protease viral integrase viral RNA polymerase viral tyrosine protein kinase viral nucleoside kinase .m F7 .0 PP The deer mouse is the natural mammalian reservoir for a virus which causes a life-threatening disease in adults in the United States. What is this virus ? A. rabies virus B. parvovirus 819 C. equine morbillivirus r12. Norwalk virus ‘M‘E‘f Sin Nombre hantavirus [4/ 5 The following set often answers (A—J, listed in alphabetical order) are to be used in answering questions #13—18. Answers can be used once. more than once. or not at all. l3. 14. 15. 16. 17. 18. measles virus parainfluenza virus parvovirus B19 respiratory syncytial virus rhinovirus adenovirus coronavirus coxsackie A virus Epstein—Barr virus influenza A virus muom> reach This virus“ which has a peak incidence in the autumn months in the U.S., is the major cause of a respiratory syndrome in infants and young children known as laryngotracheobronchitis, characterized by a “barking” cough and constriction of the airway. This human virus is the most important cause of both herpangina and a syndrome known as “hand-foot—and-mouth disease,” with both syndromes associated with vesicular exanthems or enanthems. Several serotypes of this human virus can cause pharyngoconjunctival fever, a syndrome which occurs mainly in children in summer epidemics and occasionally progresses to serious pneumonia. Observation by the physician of “Koplik’s spots” on the buccal mucosa of a patient can be very important in diagnosis of primary infection with this human virus, because these oral lesions appear several days before the more obvious clinical features of this highly contagious viral infection. Prophylactic passive immunization with a humanized monoclonal antibody (palivizumab, “Synagis”) with anti-viral specificity can significantly reduce the morbidity and mortality associated with infections in high—risk individuals with this virus. Primary infection of young adults with this human virus can result in a syndrome characterized by pharyngitis, splenomegaly and cervical lymphadenopathy. “Classical” laboratory diagnosis involved the observation of atypical large lymphocytes in peripheral blood or detection of “heterophil antibody,” but newer serological assays utilizing a panel of viral proteins are more specific and sensitive. 19‘ Ix) 22. ln the United States. which of the following modes of sexual intercourse is believed to have the highest risk of infecting a person with HIV, when neither the HlV-infected nor uninfected sexual partner is using a codom 2’ A. receptive vaginal intercourse with an HIV-infected male receptive anal intercourse with an HIV-infected male \C. vaginal intercourse with an HIV—infected female D. receptive oral intercourse with an HIV—infected male E. all of the above (A~D) have the same high risk of infection Enzymatic inhibitors of a viral neuraminidase have been developed and clinically tested in humans, with the expectation that one or several of these antiviral drugs will be licensed for oral or intranasal administration within the next year or two. Against what human virus do these neuraminidase inhibitors have specific activity ‘? cytomegalovirus influenza virus rhinovirus coxsackie virus parainfluenza virus mpd®> Viral vaccines have reduced the incidence of aseptic meningitis due to several specific human viruses in the US, but not to a group of viruses which is currently the major cause of aseptic meningitis in children. With respect to bacterial meningitis. a “conjugate” vaccine (polysaccharide antigen conjugated to protein) has eliminated the vast majority of serious meningitis cases in infants due to a specific bacterium in the last decade. What is this bacterium ? Bordetella pertussis Neisseria meningitidis Haemophilus influenzae type b Slreptoccocus agalactiae (Group B) Corynebacterium diphtheriae [email protected]> What is the group of human viruses mentioned in the previous question as the major cause of aseptic meningitis in children in the United States, with outbreaks frequently occurring in the summer and fall ? rim human enteroviruses human adenoviruses human caliciviruses human herpesviruses human parvoviruses .mp0?” lJI 24. 25. 26. A tetravalentfloral vaccine was licensed by the FDA in 1998 for human use in the US. What viral syndrome is prevented or reduced in severity by immunization with this vaccine ? A meningitis laryngeal papillomas ,‘ gastroenteritis l). hepatitis E pneumonia Vidarabine (“ara-A”) and idoxuridine are nucleoside analogues which can be used as topical antiviral agents to prevent damage of the cornea due to ocular infection with one of the following human viruses. What is this virus ? adenovirus 37 - cytomegalovirus measles virus coxsackie A24 virus herpes simplex virus 1 imbowa Serious cases of influenza virus infection which result in pneumonia are usually associated with bacterial infection, including Staphylococcus aureus, Streptococcus pneumoniae or Hoemophilus influenzae. Some recent studies suggest that there is a synergistic interaction between the virus and the bacteria, rather than just a “secondary bacterial infection.” What mechanism is proposed for this synergistic interaction in the respiratory tract ? A. bacterial inhibition of interferon tit/[3 B. removal of neuraminic acid from epithelial cell surfaces by bacterial glycosidases C. bacterial inhibition of human cell ribonucleases . D.‘ cleavage of v1ral hemagglutinln protein by bacterial proteases E. adsorption of mucosal IgA by bacterial surface polysaccharides Prophylaxis with trimethoprim—sulfamethoxazole or pentamidine is recommended for infants infected with HIV-1 to prevent Pneumocystis carinii pneumonia. Similar chemoprophylaxis is also recommended for adolescents and adults with HIV—1 infection when their CD4* T— lymphocyte count has fallen below a certain level. What is this level of CD4+ T—lymphocytes in peripheral blood, which would also qualify an HIV—infected person for meeting the current “case definition” of AIDS, even in the absence of an “AIDS-opportunistic illness” (AIDS-OI) ? A. s 800 CD4+ T cells per mm3 s 400 CD4+ T cells per mm3 a\ s 200 CD4+ T cells per mm3 D. 100 CD4Jr T cells per mm3 E. 50 CD4Jr T cells per mm3 [A l/\ 27. 29. 30. These viruses are the major cause of viral gastroenteritis in adults. and have been associated with recent outbreaks in the U.S. involving the consumption of raw oysters: human rotaviruses, including types Gl—G4 human enteroviruses, including coxsackie B viruses human parvoviruses, including parvovirus 819 human adenoviruses, including types 40 and 41 human caliciviruses, including Norwalk virus oboe? Which one of the following genes of HIV-1 and Sleac is not required for replication in T cell lines in culture, but is important for in viva pathogenicity in humans (HIV-1) and rhesus monkeys (SIVW) ? A. env ' nef Ci. pol D. tat E. gag There was an unusual human outbreak of influenza in Hong Kong in 1997 which resulted in 18 confirmed cases and 6 deaths. International cooperation of health organizations including the CDC led to identification and characterization of the Specific virus responsible for this outbreak. What was this virus ? A. avian influenza A, HlNl subtype B. avian influenza A, H3N 2 subtype avian influenza A, H5N1 subtype D. avian influenza type B E. avian influenza type C All of the following are correct concerning the FDA-licensed vaccine(s) for immunization of humans against rabies in the U.S. EXCEPT: A inactivated whole—virion vaccine produced in chick embryo fibroblast cell culture B, live-attenuated virus vaccine produced in human diploid fibroblast cell culture , C. 5 doses of vaccine recommended after potential exposure to rabid animal D vaccine administered by intramuscular injection E 3 doses of vaccine recommended for “pre-exposure” immunization of “at—risk” persons 3 l. The trigeminal ganglion is the major site of latent infection with this human virus, with the possibility of viral reactivation resulting in self-limited or potentially fatal clinical syndromes: A: 113;; C“. D. E. HIV—1 HSV-l JC papovavirus CMV EBV 32. Antiviral therapy, if initiated within the first 48 hours of respiratory symptoms, can reduce the morbidity and mortality associated with Qwerrespiratory tract infections with this virus in adults at high risk. Two alternative but related drugs are available, with one having less neurological side effects and preferred for prophylaxis, and the other potentially better as therapy because drug resistance develops less rapidly. What is the human virus whose replication is inhibited by these two antiviral drugs ? mwowa respiratory syncytial virus parainfluenza virus influenza type C virus influenza type A virus adenovirus types 4 and 7 33. Two groups of human viruses are most frequently associated with the common cold in adults and children, with distinct seasons for peak activity. These two groups of “common cold” viruses and their season(s) of peak activity are: mUOWfl coronaviruses in winter; rhinoviruses in fall and spring parainfluenza viruses in winter; enteroviruses in summer and fall caliciviruses in winter and spring; enteroviruses in summer and fall parvoviruses in winter; adenoviruses in summer and fall papillomaviruses in winter; adenoviruses in summer and fall 34. The “Tzanck smear” and “owl’s eye cells” refer to viral diagnostic assays utilizing patient specimens containing virus-infected cells. To which family do the viruses detected in these assays belong ? mdow? picornavirus paramyxovirus adenovirus herpesvirus papovavirus 35. 36. 37. 38. Sexual intercourse is presumed or demonstrated to be the major route of viral transmission between adults or adolescents for all the following human viruses EXCEPT: a. HHV—S B. EBV C. HPV—6 and —11 D. Hsv-2 E. HIV-l Maculopapular, non—vesicular exanthems are characteristic of all of the following viral diseases in children, EXCEPT: \A. varicella B. erythema infectiosum (5th disease) C. " exanthem subitum (6th disease, roseola) D. 7 measles E. rubella An anti—sense oligonucleotide known as fomivirsen has been licensed as intraocular therapy for an “opportunistic” viral infection in persons with AIDS. This antisense oligonucleotide targets mRNA transcribed from the genome of which of the following human viruses ? varicella-zoster virus (VZV) human papillomavirus type 16 (HPV-16) cytomegalovirus (CMV) Epstein—Barr virus (EBV) adenovirus type 37 (Ad 37) mdfih? Human rabies has been relatively rare in the U.S. since 1980, with only 12 “imported” cases due to exposure and infection outside the U.S. and 24 “indigenous” cases due to exposure and infection by rabies virus-infected animals within the U.S. Based upon genetic and molecular analysis of the rabies virus variants in brain tissue from these 36 human cases, the CDC has concluded that one animal variant of rabies virus is responsble for all (tithe “imported” cases and variants of rabies virus from another animal is responsible for the vast majority of the “indigenous” cases. What arelflthese animals ? «:3:— dog variant for “imported” cases and raccoon variants for “indigenous” cases dog variant for “imported” cases and bat variants for “indigenous” cases fox variant for “imported” cases and raccoon variants for “indigenous” cases dog variant for “imported” cases and skunk variants for “indigenous” cases bat variant for “imported” cases and raccoon variants for “indigenous” cases mcom> 39. 40. 41. Which of the following is a congenital disease which can currently be prevented in the U.S. by vaccination of all non—immune females of childbearing-age prior to them becoming pregnant ? congenital CMV congenital HIV hydrops fetalis CRS congenital toxoplasmosis mmowe Approximately 9% of the caucasion population is heterozygous for a mutant allele of the CCR5 gene, which contains a 32 base-pair deletion and encodes a non-functional protein. What is the implication of being homozygous for this mutant CCRS gene with respect to HIV-l _.,~..,,,...\ We“ w I .nuvmm..__ transmission or disease pr gression, comparéd’ito individuals who are homozygous for the “wild— W type” gene encoding nctional CCRS protein ? A. similar efficiency of infection, but delayed progression to AIDS (“long—term non— , ’ progressor”) B. similar efficiency of infection, but more rapid progression to AIDS (“rapid / progressor”) 'C resistance to infection by sexual route, regardless of CCR5 alleles of HIV—1 ’ V infected sexual partner(s) / D. similar efficiency of infection, but lack of transmission of HIV-1 to uninfected sexual partner(s) regardless of partner’s CCRS alleles E. no difference in infection, transmission nor disease progression of person homozygous for defective CCRS gene compared to person homozygous for “wild- type” CCRS gene If a pregnant female is known to be experiencing primary infection with this human virus in the final week of pregnancy, Caesarian section is strongly recommended to prevent perinatal infection acquired by passing through the birth canal during vaginal delivery. Morbidity and mortality associated with this perinatal infection can also be reduced by prompt IV therapy for the newborn with a specific nucleoside analogue, but passive immunization is not recommended. What is this human virus ? A. rubella virus B. cytomegalovirus C. human immunodeficiency virus—l D. varicella—zoster virus herpes simplex virus-2 l 43. 44. 45. Outbreaks of a syndrome known as “acute respiratory disease" (ARD) occurred frequently in military recruits in the late winter and spring, leading to the development and utilization of an enteric-coated live-vaccine for use by the military several decades ago. However, this vaccine is no longer being produced and the inventory of this vaccine will soon be depleted. so that ARD outbreaks will probably increase in frequency in military recruits in coming years. What virus is responsible for ARD and present in this “disappearing” vaccine? adenovirus, types 4 and 7 human papilloma virus, types 6 and 11 human coronavirus, types 1 and 2 parainfluenza virus, types 1 and 2 coxsackie A virus, type 24 mummy Development of the “new variant” form of Creutzfeldt—Jakob disease (nvCJD) is apparently associated with: corneal transplants from persons who died from C] D injections of natural growth hormone from human cadavers human consumption of food products from cattle with BSE blood transfusions from persons in early stages of CJD human consumption of food products from sheep with scrapie mafia? Which one of the following “Opportunistic” infectious agents is the greatest biohazard to health care workers treating large numbers of patients with AIDS ‘? ,,/=‘\, \A . Mycobacterium tuberculosis B. Pneumocystis carinii C. Kaposi’s sarcoma-associated herpesvirus D. Toxoplasma gondii' E. human papilloma virus Detailed epidemiological investigations were undertaken by CDC scientists during and shortly after the 1995 outbreak of Ebola virus infections in Kitwit;Zaire (Congo). What animal was identified and confirmed as the “natural reservoir” host for Ebola—Zaire virus ? A. mosquito B. snake C. monkey (Q; rodent ’ E.‘ none of the above correct, because no natural reservoir host identified 11 49. Which one of the following is not a unique feature of poxviruses‘.’ A. completion of the entire lifecycle in the cytoplasm of the host cell a, B. presence of a large repertoire of immunomodulatory genes " C\ large double-stranded DNA with a hairpin loop at both ends use of transcription enzymes from the host nucleus brickshaped structure with lateral bodies and dumbbell—shaped DNA 50. The laboratory stocks of which one of the following poxviruses, currently held by the USA and Russia, are likely to be destroyed next year because of fear of pote...
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