00:00
Let's move on to some questions.
00:03
A 63 year old hemophiliac had
contracted hepatitis B from
contaminated blood
products in the 1980's.
00:11
He stopped his medications
against medical advice
three months ago.
00:15
And presents now with fulminant
transaminitis and jaundice.
00:19
The following are true
statements about
Hepatitis B in medications.
00:25
A. Interferon alpha acts through tyrosine kinase receptors.
00:29
B. Interferon alpha is quickly absorbed at the injection site.
00:34
C. Interferon alpha inhibits ribonuclease that degrades
viral messengerRNA.
00:40
And D. Interferon alpha promotes
the formation of natural
killer cells.
00:46
So find the true statement.
00:51
Fantastic, you picked D.
00:53
Interferon alpha promotes
the formation of natural
killer cells.
00:59
Let's move on to
the next question.
01:01
A 45 year old male has
contracted influenza B.
01:05
The following
statements are true:
A. Zamanivir is an intranasal spray that may be beneficial
for this patient if taken
within 24 hours
of the onset of symptoms.
01:16
B. Amantadine may be used as a prophylaxis for this patient.
01:20
C. Rimantadine may be
beneficial for this patient
if taken within 24 hours
of the onset of symptoms.
01:28
D. Amantadine is an inhibitor
of neuraminidase.
01:32
or E. Zamanivir which acts through blockage of a proton
port in the cell wall that
prevents acidification
of the interior of the virus.
01:45
The answer is A.
01:46
Zamanivir is an intranasal
spray that may be beneficial for
this patient if taken within 24
hours of the onset of symptoms.
01:53
D is incorrect because
amantadine is a blocker of
a proton pump in the vesicle
wall, that would have allowed
transcription with an acidic environment.
02:02
E is incorrect because zamanivir
is a neuraminidase inhibitor.
02:07
It does not act
on a proton port.
02:09
Therefore, the
correct answer is A.
02:14
Let's go on to another question.
02:17
A 34 year old male represents
with a painful left eye.
02:21
He has a loss of vision
in the left visual field.
02:24
The funduscopic image
is displayed on
the following slide.
02:28
So there you have
the funuscopic image.
02:31
Now let's take a look
at our choices here.
02:35
The appropriate treatment
for this patient would be
A. Valganciclovir 900 mg orally
twice a day for 21 days
and then once a day.
02:47
B. An intravitreal injection
of ganciclovir or foscarnet
over 7 to 10 days, then valganciclovir 900 mg
twice a day for 21 days
or resolution.
03:00
C. Ganciclovir 5mg per kilogram intravenous every 12 hours
for 21 days.
03:09
Or D. Oral valganciclovir 900 mg twice a daily for 7 days.
03:16
Which is the right choice?
You chose B.
03:22
The intravitreal injection of
ganciclovir or foscarnet over
7 to 10 days, then oral
valganciclovir 900 mg
twice daily for 21 days
or until resolution.
03:35
Now for some reason, this type of question
always shows up on boards.
03:43
I've seen it when I was doing my
undergraduate exams, it showed up again
for my licensing exams,
it showed up again for my internal medicine boards,
and it showed up once again for my recertification exams.
So we see it over and over and over again
in multiple exam formats.
So exam boards love CMV retinitis.
04:01
It's a very good disease to know.
04:04
Now remember that this patient is having a retinitis that is
threatening his optic nerve,
he has loss of vision, so it's very important
to know that systemic therapy is not enough
in this situation.
04:16
So we want to give an intravitreal injection of a strong antiviral
like ganciclovir, and we give it usually every second day
for 7 to 10 days. It's followed then by
systemic therapy. So that's where oral ganciclovir
can be used for 21 days,
or alternatively we can use venous ganciclovir
for 21 days too.
Now, treatment is obviously under an eye specialist.
This is not something that we manage
in a general practitioner's clinic.
Now, we also have something called
ganciclovir intraocular implants.
These are teeny tiny little
pledgets that are very hard
to see with a naked eye and they're inserted inside
the vitreal cavity or beside the vitreal cavity
and those are obviously put in
by an eye surgeon as well. Those are very very
effective too for CMV retinitis.
That's it for our questions
I'm sure you're going to do really well.
05:11
Show them what you know.