1. Which one of the following provides a presumptive identification of a viral infection?

a. cytopathic effect on cell cultures

i. Many viruses produce changes in infected cells that is called cytopathic effect. Viruses
cannot be visualized but CPE can be detected in specific cell lines. Most laboratories
now use immunologic and molecular methods for ID of viruses, rather than the CPE.
2. The specimen of choice for detection of RSV is:
a. nasopharyngeal aspirate
i. Respiratory syncytial virus (RSV) infects the ciliated respiratory epithelium of the upper
respiratory tract. A nasopharyngeal swab or aspirate is the optimal specimen for RSV
recovery.
3. The genus of virus associated with anogenital warts, cervical dysplasia and neoplasia is:
a. human papillomavirus
i. Human papilloma virus (HPV) infects epithelial tissues throughout the body, including
skin, larynx, and anogenital tissue. Persistent infection with oncogenic types of HPV and
integration of HPV DNA into the cellular genome is a pathway leading to HPV-induced
neoplasia, such as cervical cancer.
4. Encephalitis is most commonly associated with which of the following viruses?
a. herpes simplex virus
i. Herpes simplex virus is the most common cause of fatal sporadic encephalitis in the
United States
5. Colds and other acute respiratory diseases are most often associated with:
a. adenovirus
i. Adenovirus infections are common. It causes up to 5% of all respiratory infections, and
the prevalence ofinfection is higher (up to 14%).
6. The Epstein-Barr virus is associated with which of the following?
a. Burkitt lymphoma
i. The classic clinical syndrome associated with Epstein-Barr virus (EBV) infection is
infectious mononucleosis. However, in immunocompromised patients, EBV is associated
with posttransplant lymphoproliferative disorders, and malignancies such as Burkitt
lymphoma.
7. What sample material is recommended to prepare slides for direct smear examination for virus
detection by special stains or FA technique?
a. specimen with epithelial cells
i. Since viruses are intracellular organisms, the collection of cellular material is required to
be able to demonstrate virus using stains or fluorescent techniques. Aspirates, washings
and scrapings are better specimens than swabs. Regardless of the collection method, it
is important that the specimen contain host epithelial cells.
8. Which of the following agents is the most common cause of pediatric viral gastroenteritis?
a. Rotavirus
i. Rotavirus is the most common cause of viral gastroenteritis in infants and children. It
causes >600,000 deaths annually. Coronavirus causes cold-like infections in adults and a
small percentage of pediatric diarrhea cases. Adenovirus is mostly asymptomatic,
causing a small percentage of pneumonia and gastroenteritis in children. Norwalk virus
is the most common cause of adult viral gastroenteritis and is often responsible for the
diarrheal outbreaks on cruise ships, resorts, or nursing homes.
9. Hanta or Sin Nombre virus is a Bunyavirus found in the 4 Corners area of the US (Arizona, New Mexico,
Nevada, Colorado). What is the vector?
a. deer mouse
i. Deer mouse: Peromyscus maniculatus, or the deer mouse, spreads the virus in its
infected feces. People living in close contact with animals are at a particularly high risk.
Infected individuals develop a pulmonary syndrome.
10. Which type of virus causes severe acute respiratory syndrome?
a. Coronavirus
i. Coronavirus: SARS is a severe respiratory disease spread from human to human and
caused by a coronavirus (SARS-CoV).
11. What is the animal reservoir of West Nile virus?
a. Birds
i. The host organism is the bird, which passes on the virus through a mosquito vector to
humans.
12. Which of the following organisms is the causative agent of hand, foot and mouth disease?
a. coxsackie A
i. Coxsackie A & B are frequently confused for each other in terms of the diseases that
they cause. Coxsackie A causes hand, foot, and mouth disease, so named for the most
common locations of the lesions. Coxsackie B is responsible for the majority of cases of
viral myocarditis.
13. Which one of the following viruses is responsible for the most common congenital infection in the
United States?
a. CMV
i. CMV: Passed transplacentally, the risk of in utero infection is greatest when the mother
acquires a primary CMV infection while pregnant. The effects from in utero infection can
range from severe to mild.
14. Which one of the following clinical syndromes is associated with VZV infection?
a. Shingles
i. All the other options are associated with EBV infection; shingles is the only option that is
caused by VZV.
15. Which of the following clinical presentations is associated with HHV8?
a. Kaposi sarcoma
i. Especially in the immune-compromised patient HHV8 or KSHV is associated with a
number of disease processes, also including primary effusion lymphoma. The etiologic
agent in these cases can be identified by PCR, IHC, or serological means
16. In a person vaccinated against hepatitis B virus several years prior, which serological marker would be
expected?
a. anti-HBs
i. Anti-HBs in serum indicates convalescence or immune status. All of the other choices,
with perhaps the early appearance post vaccination of HBAg, should not be seen in a
vaccinated person. HBeAg is present during active viral replication. Anti-HBc shows early
in the course of disease and shows an acute infection.
17. The persistence of which marker is the best evidence of chronic HBV infection?
a. HBsAg
i. The persistence of surface antigen is an excellent indicator of chronicity. With acute
infection and resolution surface antigen peaks 2-3 months post-infection and before
 symptoms, but is completely gone before 6 months, to be replaced by anti-surface
antibody (HBsAb) and the clinical symptoms of acute hepatitis. In chronic infection the
surface antibody does not appear, while the surface antigen persists
18. Which of the following statements regarding antigenic shift or drift in influenza is correct?
a. Antigenic drift is due to point mutations in the H&N genes
i. Drift refers to the minor changes that occur due to point mutations. Drift is primarily
responsible for the annual outbreaks and epidemics of influenza. Shift refers to a more
major change due to recombination between different viral subtypes and is most often
the cause of the periodic pandemic infections. It is due to antigenic drift and shift that
lifelong immunity to influenza cannot currently be achieved.
19. This virus is responsible for nearly all cases of infantile respiratory bronchiolitis:
a. respiratory syncytial virus
i. RSV is the most common cause of severe lower respiratory tract disease in infants and
young children. Persistence of immunity does not often occur so reinfection is common.
20. Which test is the primary screening test for HIV?
a. serum enzyme linked immunosorbent assay
i. The extremely high sensitivity of the serum ELISA test makes it the screening test of
choice. There can be a window period between the infection and seroconversion,
usually 6-8 weeks, leading to possible false-negative results. The confirmation of a
positive result is usually done with western blot, that detects antibodies to specific
antigens such as p24, p31, gp41 and gp 120/160) are positive.
21. Which of the following HIV tests is the assay for determining response to anti-retrovirals?
a. quantitative HIV RNA
i. Quantitative HIV RNA is an assessment of viral load. Quantitation of RNA levels is an
excellent prognostic tool to predict progression, especially long term.
22. Which one of the following is a characteristic of hepatitis B virus?
a. it is an enveloped DNA virus that is primarily a blood-borne pathogen
i. It is an enveloped DNA virus that is transmitted through sexual, perinatal, and
parenteral routes. The virus enters the host and travels from the blood to the liver and
infects hepatocytes.

Answers:
1. a 13. b
2. a 14. b
3. b 15. a
4. b 16. c
5. b 17. b
6. c 18. a
7. d 19. d
8. d 20. a
9. a 21. b
10. d 22. c
11. d

12. b