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65 Cards in this Set
- Front
- Back
what does corona mean in latin
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crown
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why is coronaviridae called crown?
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spikes on the envelope of the virus
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what order is coronaviridae in
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nidovirales
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describe corona virus appearance
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enveloped, nonsegmented, + sense single strange RNA virus
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who is host for corona
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vertebrate hosts
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what are two genera in family coronaviridae
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coronavirus
torovirus |
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does corona virus cause dz in both humans and animals?
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YES!
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WHAT IS THE LARGEST RNA genome know
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CORONAVIRUS
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WHAT IS SHAPE AND OTHER PHYSICAL FEATURES OF THE VIRUS
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SORT OF SPHERICAL, HELICAL NUCLEOCAPSID,
UNDERGOES FREQUENT RECOMBINATION |
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what are diseases ass with CORONAVIRUS
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COMMON COLD (25% of colds)
GASTROENTERITIS PNEUMONIA |
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DESCRIBE NON-SARS Coronovirus
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replication in upper rep tract epithelium (effect of temperature)
Responsible for 2-10% common colds (URI) Occur during colder months/periodic outbreaks |
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What is incubation for non-SARS Coronavirus
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~3days
nasal discharge and malaise small/no fever and cough and sore throat uncommon reinfection common Usually, NO DX |
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When did SARS emerge
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first pandemic of century in 11/2002 in guangdong province of sothern CHINA - 26 countries on five continents.
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what was demonstrated by SARS epidemic as far as new global world?
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potential of air travel and globalization for dissemination of emerging infectious disease.
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Describe first cases (#s deaths) and observations about sero of Sars-CoV
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Hong Kong, 8098 cases/774 deaths - CFR = 9.6%
SARS-CoV had not been endemic in humans before this. |
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What was SARS when it emerged?
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TRUE EMERGING PATHOGEN - unknown in the beginning.
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what did people think SARS was when first emerged
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influenza
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EPI OF SARS
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INCUB: 2-14 days(4-7 median)
PEAK VIRAL LOAD ~10 days |
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What happened to some patients during second week of illness
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DETERIORATION, in spite of decreasing viral load.
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WHAT IS ONE POTENTIAL PROBLEM in this DZ at this second week stage
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IMMUNOPATHOLOGIC LUNG DAMAGE
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WHERE WAS SARS PRIMARILY SPREAD?
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IN HEALTH CARE SETTINGS FROM VERY ILL PATIENTS
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Is SARS as easily spread as originally thought
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less transmissible than initially thought, with average reproduction ratio of 2-4
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what is a super-spreader?
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significantly augments spread
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what conclusions were drawn about SARS
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SARS-CoV sufficiently transmissibe to cause large epidemics but not so contagious to be uncontrollable with basic PH measures.
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who was affected by SARS
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all ages
slight preference for female(maybe because of increased exposure of nurses). Pg women and Immunocomp pts. |
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was virus just found in respiratory secretions
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no, feces, urine and tissue specimens form lung biopsy also.
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what is primary mode of transmission for SARS
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direct or indirect contact of mucous membrane(eyes, nose or mouth) with infectious respiratory droplets or fomites.
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what is thought to amplify transmission of SARS (HINT - HOSPITAL SETTINGS)
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aerosol-generating procedures (trach intubation, bronchoscopy and tx with aerosolized meds)
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is there evidence of transmission before disease onset?
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NO
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is transmission to casual contacts common in SARS
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NO!
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WHEN IS THE LAST POINT THAT TRANSMISSION OCCURS DURING THE CLINICAL PHASE?
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none after >10 days after fever resolution.
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What is the replication number for SARS
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Ro ~ 2
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is F/O transmission important in SARS
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Could be - not known for sure. watery diarrhea common, shed in stool in large quantity. no trans btw children.
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is there any food/waterborne or vertical/perinatal transmission known?
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NO
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talk about super-spreaders in SARS
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most super spreaders do not become super spreaders. Undetected hosp cases and aerosol generating procedures.
Role of other biologic and host behavioral factors? |
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What factors are thought to be associated with super spreaders of SARS
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lots of contacts (social)
HIV/immunocomp - Biologic |
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Can SARS survive for days in environment?
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yes, in feces and dried on surfaces in alkaline pH
Much more stable than other human resp viruses(more so than RSV) yes |
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talk about Amoy Gardens Outbreak
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> 300 cases in aptment complex in HK- leading hypothesis is that droplets with virus entered bathrooms from contaminated sewage in bad U-trap plumbing.
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what is ground zero?
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direct transmission
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was there something significant about viruses form guangdong province?
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more genetically diverse
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Were there variations of virus
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yes, genetic lineages distinct form index case in HK
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describe disease progression of sars
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1/3 - rapid defervescence & resolution of radiographic changes.
2/3 persisten fever, worsened resp status, diarrhea |
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key sign in the mediastinum?
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pneumomediastinum w/o preceding +pressure ventilation or intubation.
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what % of SARS pts require ICU tx
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20-30%, most requiring mechanical ventilation.
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what were common terminal events?
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resp failure, Mult organ failure, sepsis, inter-current medical illness such as acute myo infarction.(out of the blue, heart attack)
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what were best diagnostics
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early RT-PCR on resp and fecal spec - some + > 30 days after illness, rarely isolated virus after 3rd wk of dz.
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what were late diagnostics
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>1 week - serology via ELISA or IFA
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what was SARS Pathogenesis
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Viral RNA byRT-PCR - hi copies in lung, bowel, liver, spleen, lymph nodes and kidney
AGN in lung: Alveolar epith cells mphages and bronchial epithelial cells. |
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lab finds
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hi lymphs
leukopenia thrombocytopenia anemia inc LDH incALT |
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was there anything early on to identify SARS
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NO, not particularly. key point.
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Pathogenesis of SARS
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Viral RNA by RT-PCR in lung, bowel, lymphn odes, spleen, liver and kidney
Viral AGN in lung - epith cells/Mphages and bronchial epith cells |
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what was key factor in controlling pandemic in SARS
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lab techs were great and had great diagnostix
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What is associated with poor prog in SARS
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age - old - >50% over 65/kids not so bad
co-existing dz - diabetes and heart INC LACTATE DEHYDRO - indicates hemolysis, can mean MI INC NEUTROPHIL COUNT LOW CD4 AND CD8 COUNTS |
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WHAT IS TX FOR SARS
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SUPPORTIVE
BROAD SPEC ABIOTIX |
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WHAT IS NOT INDICATED FOR SARS
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don't know about:
ribavirin, thymic peptides, recomb thymus proteins, iv igg, IgM enriched Igg, convalescent plasma trad CHinese herbs |
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what are possible drug strategies for SARS
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IN VITRO: susc to Interferon alpha, Interferon beta, Glcyrrhizin(licorice root extract)
IN VIVO: Pegylated interferon alpha in macaque model reduced viral load both pre post exposure CORTICOSTEROID - NO NEGATVE EFFECT, NO PROVEN |
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What is SARS chronic sequelae
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6-20% some degree of respiratory impairment
- residual lung fibrosis -mm weakness -systemic effects of viral illness PTSD DEPRESSION BREATHE BY NEG P - BARIO TRAUMA IS POS P ON VENTILATOR |
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Describe Public Health resonse
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-early case detection
-triage and isolation -public ed -contact tracing and QUARANTINE -Surveillance @ border xings (forms and fever detection) -enhanced hospital inf-cont practices(aerosol precautions and resp droplet precautions) -Vaccine research |
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who was wrongly blamed initially in the SARS outbreak?
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CIVET CATS
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RESERVOIR FOR SARS
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BATS(horseshoe bat)
Civet catsRaccoon dog ferrets wild animal trade |
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challenges from SARS
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New disease - source, mode spread, dx methods, tx, and case fatality all unknown
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other SARS challenges
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-Transmission often inhospital
-successful prevention measures require vig and $$$ -Multinat'l outbreak language, cultural diff complicated politics implications for travel/economix |
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what was good about SARS epi
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-rapid mobilization of global expertise
-overall good int'l collab -tech comng thru etiologic agent identified fast lab diagnostix under dev |
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What needed work in confronting SARS
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-not all countries forthcoming with info
-exposed poor surveillance in some countries -global network coordination still challenging |
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what happened in Hanoi SARS cases
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higher fatal rate - 10.9%
all cases linked to same hospital nosocomial, 2nd and 3rd transmissions observed. |