2. 1 - $1001 - $100
CMV is this type of virus, which is this type ofCMV is this type of virus, which is this type of
virus.virus.
Herpesviruses (HHV), double stranded DNAHerpesviruses (HHV), double stranded DNA
virusvirus
3. 1 - $2001 - $200
CMV latency site (reminder, HSV and VSV hangCMV latency site (reminder, HSV and VSV hang
out in the nerve root ganglion)out in the nerve root ganglion)
Monocyte, lymphocyte, endothelial cell, epithelialMonocyte, lymphocyte, endothelial cell, epithelial
cells.cells.
5. 1 - $4001 - $400
EBV and CMV both cause mononucleosisEBV and CMV both cause mononucleosis
infections. What are lab findings that mightinfections. What are lab findings that might
distinguish EBV and CMV?distinguish EBV and CMV?
EBV: monospot +, lymphocytosis, elevated LDHEBV: monospot +, lymphocytosis, elevated LDH
CMV: monospot -, leukopeniaCMV: monospot -, leukopenia
6. 1 - $5001 - $500
Infected cells have these characteristicInfected cells have these characteristic
inclusionsinclusions
Owl eyesOwl eyes
7. 2 - $1002 - $100
Symptoms of acute CMV infectionSymptoms of acute CMV infection
Usually asymptomaticUsually asymptomatic
virus remains latent in the monocyte,virus remains latent in the monocyte,
lymphocyte, endothelial cell, and epithelial celllymphocyte, endothelial cell, and epithelial cell
9. 2 - $300—MKSAP #82 - $300—MKSAP #8
40F with AIDS (CD4=54) is admitted for 1 mo diffuse abd pain,40F with AIDS (CD4=54) is admitted for 1 mo diffuse abd pain,
fever, sweats, fatigue, and wt loss. No swallowing or other focal sx.fever, sweats, fatigue, and wt loss. No swallowing or other focal sx.
PE: diffuse lymphadenopathy, hepatosplenomegaly. WBC 3.6,PE: diffuse lymphadenopathy, hepatosplenomegaly. WBC 3.6,
elevated alk phos, otherwise LFTs normal. Abd CT with diffuseelevated alk phos, otherwise LFTs normal. Abd CT with diffuse
hepatic and splenic enlargement, nl small bowel, lymphadenopathy.hepatic and splenic enlargement, nl small bowel, lymphadenopathy.
What is the diagnosis?What is the diagnosis?
A) CMV infectionA) CMV infection
B) disseminated candidal infectionB) disseminated candidal infection
C) disseminatedC) disseminated mycobacteriummycobacterium avium complex infectionavium complex infection
D) Mediation toxicityD) Mediation toxicity
C) Reminder that the symptoms of disseminated CMV in patient
with AIDS is retinitis and esophagitis, cytopenias, etc. Focal
organ involvement
10. 2 - $4002 - $400
CMV retinitis has this characteristic PE findingCMV retinitis has this characteristic PE finding
Cotton wool spotsCotton wool spots
Edematous and ischemicEdematous and ischemic
neuronal tissueneuronal tissue
11. 2 - $500—MKSAP#482 - $500—MKSAP#48
44M evaluted for acute rejection of a transplanted kidney. PMH44M evaluted for acute rejection of a transplanted kidney. PMH
ADPKD, renal transplant D-/R- CMV 18mo ago. Meds includeADPKD, renal transplant D-/R- CMV 18mo ago. Meds include
amlodipine, tacrolimus, prednisone, and mycophenolate mofetil. WBCamlodipine, tacrolimus, prednisone, and mycophenolate mofetil. WBC
4.5, Cr 1.8. What infection should this patient receive prophylaxis?4.5, Cr 1.8. What infection should this patient receive prophylaxis?
A) aspergillus, B) CMV, C) PJP, D) MACA) aspergillus, B) CMV, C) PJP, D) MAC
C—PJP higher immunosuppressive medicationC—PJP higher immunosuppressive medication
in the setting of the acute rejection (usually 6-12in the setting of the acute rejection (usually 6-12
months).months).
12. 3 - $1003 - $100
Treatment of CMV, ganciclovir has thisTreatment of CMV, ganciclovir has this
mechanism of actionmechanism of action
Guanosine analog. Inhibits viral DNAGuanosine analog. Inhibits viral DNA
polymerase by chain terminationpolymerase by chain termination
13. 3 - $2003 - $200
Name two guanosine analogs do not have anName two guanosine analogs do not have an
affect on CMVaffect on CMV
Acyclovir, valacylovir, famciclovirAcyclovir, valacylovir, famciclovir
14. 3 - $3003 - $300
Name 3 first or second line treatments for CMVName 3 first or second line treatments for CMV
First line ganciclovir (IV) and valgancyclovirFirst line ganciclovir (IV) and valgancyclovir
Second line foscarnet and cidofovirSecond line foscarnet and cidofovir
15. 3 - $4003 - $400
Distinguish active, latent, and secondary CMVDistinguish active, latent, and secondary CMV
infection in a post transplant orinfection in a post transplant or
immunocompromised patientimmunocompromised patient
Active infection – presence of CMV in bloodActive infection – presence of CMV in blood
Latent infection – after resolution of the acuteLatent infection – after resolution of the acute
infection, patient is CMV +infection, patient is CMV +
Secondary infection – reactivation of latentSecondary infection – reactivation of latent
infectioninfection
16. 3 - $5003 - $500
TreatmentTreatment of drug resistant CMVof drug resistant CMV
Add foscarnateAdd foscarnate
Decrease immunosuppressionDecrease immunosuppression
IV GALCYCLOVIR – INCREASED DOSEIV GALCYCLOVIR – INCREASED DOSE
17. 4 - $1004 - $100
I say findings, you say HHV type.I say findings, you say HHV type.
HepatosplenomegalyHepatosplenomegaly
EBV – splenomegaly seen in about 50% ofEBV – splenomegaly seen in about 50% of
patientspatients
18. 4 - $2004 - $200
I say findings, you say HHV type.I say findings, you say HHV type.
Temporal lobe encephalitisTemporal lobe encephalitis
HSV 1HSV 1
19. 4 - $3004 - $300
I say findings, you say HHV type.I say findings, you say HHV type.
retinitisretinitis
CMV (“sight”omegalovirus)CMV (“sight”omegalovirus)
20. 4 - $4004 - $400
I say findings, you say HHV type.I say findings, you say HHV type.
Pharyngitis, lymphadenopathyPharyngitis, lymphadenopathy
EBVEBV
21. 4 - $500 – MKSAP #554 - $500 – MKSAP #55
35F with PBC s/p liver transplant 3 mo ago evaluated for35F with PBC s/p liver transplant 3 mo ago evaluated for
fever, fatigue, sweats, and dull midchest pain for 2fever, fatigue, sweats, and dull midchest pain for 2
weeks. She was seronegative for CMV and EBV, butweeks. She was seronegative for CMV and EBV, but
donor positive for both. Medications include tacrolimus,donor positive for both. Medications include tacrolimus,
prednisone, mycophenolate, mofetil, and bactrim. CTprednisone, mycophenolate, mofetil, and bactrim. CT
chest 3cm hilar LN.chest 3cm hilar LN.
Which of the following is the most likely cause of clinicalWhich of the following is the most likely cause of clinical
findings?findings?
A) CMV B) invasive candidal infection, C) post transplantA) CMV B) invasive candidal infection, C) post transplant
lymphoproliferative disease, D) reactivation of TBlymphoproliferative disease, D) reactivation of TB
PTLD, B cell proliferation, which is induced byPTLD, B cell proliferation, which is induced by
EBV.EBV.