DIP Episode 218 - Comprehensive USMLE Step 1 Micro Review Part 3 (Viruses)

Good morning. My name is Devine. This is episode 218 of the Devine Intervention Podcast. And into this podcast I'll be continuing the comprehensive microbiology review series for the US 7 Listup 1 exam. This will be episode 218 and I'm going to be talking about the viruses. So let's jump right into it. So the thing is, and I'm actually going to be trying something you're at the end. I'll just maybe spend like a minute talking about like a life lesson that's useful for like mid-student and professionalism in healthcare. And you know, hopefully you find that to be, you know, helpful. Just kind of going forward. So let's just get ready into it. So you kind of want to know some basics about viruses. And unfortunately one of the things with viruses is there's a lot of memorization associated with it. So I try to kind of come up with some rules that should be able to help you quite significantly with kind of grouping things together. Really, my career is about like just being able to group things appropriately. If you can group things well, then you can remember a lot of the information. And it's also useful to know things in a clinical context. So if you notice from the first two installments in the series, I try to be as clinical in my presentation of micro, because I feel like those are the things that will ultimately help you do it on the exam. So viruses, right? You can classify some viruses as being either the annual RNA viruses.

You can classify them as being double or single stranded viruses. And then there are positive and negative sense viruses. The positive sense viruses. Essentially they're mRNA, right? They have the ability to actually infect all cells. The negative sense RNA viruses, again, the negative sense cannot be, cannot essentially be, it cannot be transcribed. I mean, sorry, it cannot be translated. So the negative sense RNA viruses, you actually need to convert the negative sense strand to a positive sense strand. And you do that with an RNA dependent RNA polymerase, right? That means it's an RNA polymerase that depends on RNA as its template, right? So with that, you're able to make like the positive strand. And then that positive sense strand can then go ahead and infect the cell. And the thing is for the most part, all RNA viruses are single stranded. There's one notable exception to that sort of virus. Embroidered virus is that thing that cause is the most common cause of the RNA in kids on NV Me exams. And also in the rural reduction, the non-stickin. And then all the DNA virus, remember the DNA for the DNA double stranded, right? But again, there's a notable exception. That's probably 19, right? That's actually a single stranded DNA virus that's transmitted via the air somizer out. And then all the GI viruses, all the atroport born viruses, they are all positive sense RNA viruses. So again, those can directly infect the host cell. And then I cause a hydroviruses.

They could be naked. So that means they have no capsule, right? And if you look at viruses that are helical, they are all encapsulated. And there are some envelope viruses that essentially there's one thing they do where they use fusion proteins to move from one cell to the other. When they do these things, they're actually able to evade the immune system. And this is potentially wise on viruses lead to the formation of montaneucleidate giant cells. Right? So like the herpes virus, for example. Now, the thing is actually a virus that is non-onvuloped, right? This thing is kind of counterintuitive. It's one of those high-yield things to look for examples. Non-onvuloped viruses, they actually end up being sturdier than envelope viruses, right? So because they are very sturdier, they tend to be transmitted via the fecal oral route. Right? So like hip A and hip E. I remember A and E at the beginning and end. So that's like hip A is the beginning, hip E is the end of the hepatitis virus out for that. Right? So that should help you remember that those are transmitted via the oral fecal route. Right? So like remember like your mouth and your anus, I kind of like the two with the orifices of your body. I know it's kind of a gross amount, but it's very effective. You'll likely be an indelible impression in your mind. So what are some key other key things to keep in mind again. I've kind of mentioned this already, but repetition always helps. Right?

So all the viruses, they are double stranded except probably 19. Again, remember probably 19 is the slap-cheekrash deal. And I will see some more things about it later. Because it's the slap-cheekrash. Excuse me. So because it's the slap-cheekrash and it also can cause like joint pain like migratory arthritis. And elementary school teachers and then all the RNA viruses, right? The single stranded with one exception, a rotavirus. And again, like I said, they're really little kids, right? And the thing is any DNA virus that ends with the letter A has a circular genome. Right? That's just one of those rules you can keep in mind. If you have any DNA virus that ends with a letter A, it has a circular genome. All of the DNA viruses have linear genomes. And for the most part, most DNA viruses, they actually replicate, they actually replicate like in the nucleus. They typically do not replicate in the cytoplasm. The exception to that is the Pox virus, right? The Pox virus actually has its own DNA-dependent RNA polymerase, right? So that means it's an RNA polymerase. That means it makes RNA what it's dependent on DNA as a template. And the thing is all the DNA viruses, again, they are enveloped with some key exceptions, right? So we have like powerful virus, abnormal virus, and the popover viruses, right? And then most of the DNA viruses, they actually get their envelopes from the plasma membrane, but there are some key exceptions here.

The Herpes virus actually gets its envelope from the nucleus and HB, right? Remember, HB is the one that tends to be transmitted via like sexually into a course. It actually gets its envelope from the endoplasmic reticulum. Again, I know some of you may be saying, I'm talking about super low yield, but I promise you it's super high yield to know for the exact. So I decided to kind of make like a table that emphasizes some key classifications because sometimes one thing your friends at the NV Me do is they'll write a question about like a virus. And then the answer, like you know what the virus is, but they will now start writing answers and say single stranded positive RNA, blah, blah, blah, blah, blah. So I kind of try to divide them for you and put the high yield viruses under these nice and easier categories, right? So the RNA viruses for the most part, they tend to be equals a hydro, you can have those that are enveloped, you can have those that are not enveloped under the envelope group. We have those that are positive sense, right? Non-segmented, right? So these are ones that essentially mRNA, so they can directly affect the nucleus because they can be true. Which that positive sense RNA can be translated directly into protein, right? So it's very effective. So under that, we have like the picornoviruses, right? So we have like the rhino virus, the rhino virus, rhino virus.

Remember, it's the most common cause of the common code, although I mean, like if you've watched the news or if you're existing, you probably heard about the coronavirus and like the bad news that's causing all over the world. And then there is the enteroviruses, they also picornoviruses. And under that, we have the polio virus. Remember, that tends to torch the anterior horn of the spinal cord. And we have hip A. Remember, fecal or rarout just has only, remember the A in hip A for the A in acute, only causes acute infection. And then we also have the coxacchi viruses. Remember, we have coxacchi A that causes hand-foot mouth disease. And they will have coxacchi B that causes some Ayukraditis that then ultimately lead to a diluted cardiomyopathy. And then, under those, that positive sense, months segmented, again, we have the calisi viruses. And under the calisi viruses, we have hepatitis E. Remember, that's the one that has pretty high mortality in pregnant women. And also again, fecal or rarout transmission. And then we have the no-o virus, right? That's where we have like no-ovirus, like diarrhea and cruise ships, stuff like that. If you see diarrhea with alf bricks, think about no-ovirus on MBME exams. And then, under those envelope rarout viruses, we also have the double stranded as segmented. I'll say probably the big one to know there is rotavirus. So I'm going to leave that.

And then, going back to the very top, like the rarout viruses, again, most of them are in the course of the hydro. We have the non-ovolved. And under that, we have like the single stranded, non-segmented, positive sense, right? So positive sense, non-segmented. Remember, all the rarout viruses are single stranded with the exception of rotavirus, right? Retavirus. So, under the non-segmented, positive sense, single stranded, non-ovolved. We have like the Toga viruses. We have like the alpha and the ruby viruses. And then, under that, we also have the flavy virus, right? And that's where we have like hep C for the most part. And then, under the non-ovolved viruses, we also have like again, the positive sense deployed. And there we have the retroviruses, right? So like, lentiviruses there, like HTLV1 and 2, right? Those T-celled and infotropic viruses, they all there. So just think of kind of like the algorithm that exists in first aid, the gram-negative gram positive algorithm. Think of this as an RNA virus algorithm. I would encourage you to commit this to memory. It should help you tremendously in your test. And then, I just essentially made the same thing, but I just added some very quick, high old things here that I think can help you, help you in your test. Just like if you wanted like a very quick wrap-up review before you take your exam. This slide number six is probably a useful one to commit to memory, right?

So again, RNA viruses, you know, again, for the most part, the anacosahedron. And under the envelope, again, we have the single-stranded positive sense, non-segmented. We have the Toga virus there. And again, these are all enveloped, right? So the Toga virus, we have a rebella there. Remember, rebella tends to cause a posterior recall in fattenopathy. It just cause like a 3-d rash. And then the Toga virus is, you also have like the equine and cephalitis viruses. Those are like the alpha viruses, if you may. Those are usually transmitted through the viruses. That's probably the biggest thing you want to know on the exams. And then on the, again, another group on the positive sense, non-segmented, right? Unveloped RNA viruses. We have the free-view virus. There we have Hep C, right? Remember, it can cause hepatocellular carcinoma, tends to be transmitted through like blood transfusions, has the longest incubation period of all the hepatitis viruses. And it's also common in IV drug users, right? We also have the West Nile virus under the free-view virus. And then we also have like the yellow fever. And like the dengue fever, remember, dengue, right? It's transmitted by the 80s mosquito. And it's the thing that causes like this break back fever, right? And then under the non-unveloped RNA viruses, we have like the positive sense non-segmented, right? And there we have two groups. We have the PCORN viruses and the Calisi viruses. I'll talk about the PCORN viruses first.

We have a rhino virus. Remember, that's the most common cause of the common cold, right? And it's transmitted by the respiratory route. And then we also have the interoviruses, right? On the PCORN viruses, we have polio, again remember, it torches the ventral horn of the spinal cord, so it causes like a flasid paralysis, like low moron neurons and symptoms. And it also has fecal oral transmission. Remember, there's the seabing vaccine. That's the live-attended vaccine. It's the oral vaccine. Remember, you don't give those to like pregnant women or kids on the beach of one on MBME exams. If a person is like super immunocompromised, you give the salt vaccine, that's the killed. So remember, the key at the end of salt for kill, right? That's the one you can. That's the injectable vaccine versus the seabing vaccine that's actually oral. And then hip A, right? He's also under the interoviruses. Remember, it has the shortest incubation time of all the hepatitis viruses. Remember, hepsis, the one that has the longest incubation time. And hip A, right? It's, you know, people can be symptomatic. They can have like a flori-tip acute hepatitis, whether it is the AO Ts and the thousands, you know, usually some body care fluids. Those people tend to recover pretty well. And there is actually a vaccine available for it. And again, fecal oral transmission, as I've mentioned earlier on. And then we have the coxacu virus. Heps also under the pecorino viruses.

We have coxacu A, hand-foot mounted Z, coxacu B. That's the most common cause of viral microchiditis. I mean, the virus is generally the most difficult cause is like a dietic cardiomyopathy. So the way that we present for an in-bimics, and we'll be a person that, you know, recently had like some upper respiratory symptoms. And now the Brazilian short of breath has a new S3 heart sound and what not, right? And then also under the interoviruses, we have the echo virus tends to cause like a viral meningitis. And then again, on that positive sense, non-segmented RNA viruses, the ones that are non-unveloped. We have the calisi viruses. There we have the normal virus. Again, cruise ship gastroenteritis, outbreak gastroenteritis. And then we also have hep E under the calisi viruses. Remember, it's really about impregnant women, fecal oral transmission, very common in Asia. So if they give you a question about a person from Thailand or whatever, you know, pregnant woman from Thailand, think about hep E, right? And then under the non-unveloped RNA viruses, we have the double stranded segmented. The big one we have there is rotavirus, right? Those are the real virility. We have the rotavirus is the most common cause actually of a viral gastroenteritis in kids, tends to have like the genomic reasortment or talk about that in a bit. And then, you know, you can also talk about the coltivirus, that's the thing that causes the Colorado at tick fever. That's super low yield.

Okay, so let's say some high yield things on the RNA viruses, right? So remember the coronavirus. It's one of those things that you should probably expect to see increased measure on MB and E's because it has killed so many people in recent times, right? So remember, it's a positive sense, single stranded RNA virus. Remember, it's the thing that causes SARS, right? So if you remember SARS from back in the day, that was actually caused by the coronavirus. And they don't forget the mom's virus, right? The mom's virus. It's essentially the classic presentation of the present that has parotitis. So that's the kind of virus that's called parotitis. Right? And the rachitis. So that's like big testicles. It could also cause meningitis, but that's a little low yield, right? And then measles, right? Measles, right, has the three C's, right? So the cough, choriza, choriza is just a 5 medical term for, for running nose, right? And then conjunctivitis, right? So cough, choriza, conjunctivitis. And remember that you can also get like, a couple of spots out, a clearly look at pictures of this, a couple of spots on the Bucomicoster. The thing is, it can actually reactivate later in life, and it can actually cause this thing called SSP, like a sobriquid, sclerosis, impolence, a phyitis. They will talk about a person that had a history of measles like back in the day, recovered, and then years later, the child is no longer doing super well in school, the child becomes scumatos and dyes.

I mean, like the mortality with SS Ps almost 100%, it's pretty bad. And the thing is, if a person is like, you know, going through like a measles progrom, actually giving vitamin A improves, I think, morbidity. So it actually kind of helps. And then the rabies virus, right? It's from the rabble virus family. You know, you can get it through exposure to like animals, like bats, raccoons, dogs, super long incubation period, and usually travels through like motor neurons, right? So your friends at the NVME could probably write like a self-hesiology question for this, where you need to remember that, oh, it's, it's kainese. No, it's, it's, it's dining, right? Dining that does retrograde transport, right? So like from the synapse all the way back to the cell body, right? And the thing is once you get to your CNS, that's the end, right? That's literally the end. The fatalities like 100%. Usually when you suspect the person has been exposed to rabies, you give them like the rabies in theoglobulin, and then you also give them the kiloboxin, right? So that you can have both immediate and long-term immunity. You give those things in separate arms. It's just one of those bizarre things you've seen on a test. You don't give it in the same arm because you don't want to give the immunoglobulin that will bind up the vaccine or give it in the percept, right? And all the RNA viruses, again, they're replicating the cytoplasm with the exception of the retroviruses, right?

And also the influenza virus. And then don't forget, right? The influenza virus, right, is what causes the flu, not H flu. H flu does not cause the flu. I know it's kind of obvious, but it's just one of those things, you know, in the heat of an exam, people can make like spurious mistakes. And the thing is, it's a very segmented virus, right? And it does like a genetic rears sort of into it. Essentially, you know, like, let's say you have this one animal, and one influenza virus infects that animal. And then some other animal viruses, so some other influenza viruses infect the same animal. And then they just mix and mash up like the different segments of the genomes. That's the thing that causes an antigenic shift, okay? An antigenic shift is super severe, causes severe pandemics, right? So a pandemic, right? Like panic, right? Think of panic, right? So that's usually pretty bad. But if you have like point mutations in the genome, right? Like the genes that quote for like hemoglotenin and uraminides, right? That's what this one antigenic drift. So you see a drift, causes, you know, for the most part, causes like an epidemic is less severe. So you see like drift, it doesn't sound as dramatic as a shift, right? A shift is severe. A drift is not as dramatic, right? And remember, you probably hear of the influenza virus like here, like H1 N1 and all that stuff. The H in H1 stands for hemoglotenin, the N in N1 stands for uraminides, right?

So the thing is, hemoglotenin is actually the molecule that helps the influenza virus attach to the host so they can get into your right? So that's like the passport to get into the cell, right? And that's actually what's targeted by the influenza vaccine. And then uraminides is essentially the enzyme that cleaves the viral particles, right? Usually the viral particles they are connected to cellica said. So you cleave the viral particles from cellica said so that the cell can leave the host cell it has infected and, you know, one, do its bidding in other cells, right? The thing is, uraminides is actually what is targeted by the uraminides inhibitors, right? That's a very creative term, like, also tamivian and zanami vian, right? Again, these are how you things to do. And again, I know you some of you may be seeing the volume. We don't seem to be talking about pharmacology in these videos. I have very comprehensive podcasts on all the antibiotics and antivirals and antifongals and antipyrosetics. I've made podcasts on them. So just go on my website, click on Exam Topics list, and then you'll see like the different pharmacologies listed there. So I'll just encourage you to do that. And then we have like the parian influenza virus and the RSV virus, right? So remember those are the parian influenza viruses, remember the parian influenza virus causes a group, right?

So in the findings of a writing group on the exam, just to match with your head, you'll call it like a laryngo tricubrointitis. So if you tell you that a person has like a seal-like barking cough, just, you know, don't bother reading the rest of the question. It's parian influenza. And essentially, those people have strider because it's an upper-early problem, right? And it's a sub-bloodic problem. Epiglotytes is above the blotus. It's a super-bloodic problem, but a group or laryngo tricubrointitis, no longer a sub-bloodic problem. That's a high-eof-fat-toi to know just for step one, or for your pizza shelf in 30 M for step 2cK. Now, RSV, it's actually the most common cause of bronchialitis and infants. So if you talk, if you see a question about like viral pneumonia and an infant, like a kid that's like three years old or less or thereabouts and they tell you, oh, you get a chest check, sure you see it in testicially in filtrates. You want to definitely think about RSV. And for the most part, you'll have wheezing, right? Because bronchialitis is a lower-early problem. So lower-early problems tend to present with wheezing. Upper-early problems tend to present with strider. And one common example to stick, I kind of want to correct here, so that you don't make it on a test, is like the difference between like rubella, rubiola and rosiola. You see, there's some very similar enough to where people can kind of screw them up on exams, right?

So remember, the rubella virus is part of the Togo virus family and it causes German measles, right? That's the thing that's called like the 3 D measles. Contrary to our rubiola, rubiola is the thing that causes like the legit measles. Like when you hear the term measles, like this is the thing that actually causes measles, right? When it's a rash that starts on the head and kind of moves down towards the toes, right? And then we also have the rosiola virus. That's who manherpies virus number six, right? Remember, this tends to cause like fever, causes like a rash in infants. So please don't mix this up on a test. Rosiola, the way we'll present is the child will have a very high fever, like 103, 105, like super impressive fever. And then the fever will break and then like three days later a rash kind of comes up. That's the way to kind of keep that straight. So now let's kind of go to the DNA viruses. I didn't create a chart for the DNA viruses because there's not many of them that you need to know. So it's just probably easier to just go ahead and just remember the quikets with each one. But basically we start with admovirus, right? It's a thing that essentially causes most cases of pink eye, right? So it causes like a conjunctivitis. So if the tell you that a person has a firing go conjunctivitis or like so through that pink eye on a test. So conjunctival injection and so through it. Think about admovirus. Remember it also causes hemorrhagic cystitis.

Limitily about like a child at a decade that has like radiating. If you see that, think about admovirus. What's the other bug that causes hemorrhagic cystitis on exerves? Think about a person from Egypt. I really hope you're going after she's to somahematobium, right? And then what's the drug that can cause hemorrhagic cystitis on NBM Es? It's an anti-cancer drug that's also like a risk factor for bladder cancer. I hope you're telling me cyclophosphamide, right? Remember cyclophosphamide has a metabolic known as acroline. And that acroline can is a vesicant. It can't torture the bladder. So that's why it typically gives mesmer, right? And you give like a ton of hydration, you irrigate the bladder when a person is taking an acythematosophamide. And then don't forget the pox virus, right? Causes a smallpox and again a replicates in the cynozole. Now probably in the 19, right? This is super high-yout virus to know about. All the DNA viruses are double-stranded with this one exception. It's a single-stranded DNA virus. So probably in the 19, it causes fifth disease, right? Classic presentation of exams, childhood and slap-cheek rash, right? That has like a rash, has like a throgeus. And the one buzzword you may see on a test is like everything I'm infectious, so, right? And the thing is it can also, in fact, the NBM is beginning to move away from the slap-cheek rash, because they know every human being has memorized it.

They're beginning to go more towards elementary school teachers, right? So if you see an elementary school teacher that has like migratory joint bay, that's a parvo B19, pretty much, right? And again, this is one of those viruses that doesn't leave when you don't with step one. It makes a very strong appearance on step 2 CK, on the pit shelf, on the internal medicine shelf, on step 3. So you're just going to keep in mind. And the thing is probably 19 lost to, in fact, like the arithroid stem cells, right? So you can cause like a pure etsyloplicia, so your hemoglobin, your hemoglobin will be super low. Remember, you actually, you're up, your other like non-rebloat cell lines actually intact for the most part. So like your platelets, your white counts, those are really pretty okay. And the method of transmission already is through respiratory maculation. And for the most part, if a person gets parvo B19, you know, they'll get an anemia from it, they can usually like overcome the hump. But if you have whatever the soil or wear like your arithritis don't leave for very long like phallastemia or sickle cell disease, or your arithritis leaves for less than four months, for less than 120 days, essentially. And then our happen is those people can go into any plastic crisis and die, right? And the thing is probably 19 if you get it congenitalia, right? That can actually cause hydroxythylus. I'll talk about the mechanism because hydroxythylus many people just memorize the buzzword.

But you don't actually understand what in the world that actually means, right? So I'll talk about what that means right now. So the thing is, if for example right here, arithroid progenitors infected with parvo B19, right? They won't work. Well, if they don't work, you're not going to produce red blood cells. So you're going to have an anemia with that. Well, if you have an anemia, the thing is if you remember the oxygen carrying capacity equation of blood, right? I'll talk about that when I do my poem, when I do my poem videos, slash podcasts. Essentially, hemoglobin is part of that thing. So if you have low hemoglobin, right? Your oxygen carrying capacity of blood will be decreased, right? Although your p little ill too, so the oxygen tension in your blood and your SAO to your hemoglobin saturation, hemoglobin saturation of oxygen will be normal, right? So your oxygen content will go down, right? And because the oxygen content goes down, that will cause hypoxemia, right? And the thing is when there is hypoxemia, your heart is like, like your tissues are like, we need more oxygen, we need more oxygen. So let's say every minute your heart does like 60 cycles around the body. Your heart will be like, okay, I understand, you need more oxygen. Let's maybe do 150 cycles, right? So your heart will keep pumping, pumping, pumping, pumping, pumping, pumping. The thing is, you know, when you exercise, your heart rate goes up, that's good for that period, right?

And you know, your heart can sustain for that period. But if your heart rate is like super high all the time, because you are constantly hypoxic, then the heart can burn out after a while, right? I mean, there is, in fact, there is a reason why people have like tacky redness for prolonged sustained periods. You can get into trouble, there's this thing called like a tacky cardia induced cardiomyopathy, right? So the thing is, when the heart, you know, is like working hard, it's almost like you've cast a spell on someone to like work out forever, right? Working out is good, anything in excess is never good, right? So if you're working out forever, your heart rate is always up and all that stuff, that's bad. After a while, the heart will just kind of like, just crap out and just die. It's almost like, just like, okay, I can't take this anymore. I can't keep working on this heart rate, right? But not for super sustained periods, right? So the thing is, if the heart craps out, the heart will fluid begin to accumulate, because the heart is no longer pumping blood for us, well as it should. So fluid will be accumulated in like all the areas of the body, and the kids' body will swell, right? That's why it's called hydroxythylis. It's a swelling of the body of a fetus, right? This is actually a pretty good example of high-up or heart failure.

In fact, I can foresee your friends at the Mbimmy right in a question where they're putting hydroxythylis so they can ask for the mechanism behind hydroxythylis. It's an example of high-up or heart failure. I'll say some more things about high-up or heart failure in my cardiology videos in the future. Now, so HPV, right? That's another high-yogin virus. Causes cervical cancer, causes muscle cancer of the cervix. Remember, there are loris and high-risk HP Vs, right? There is like HPV1 and 6 that tends to cause like, plantar awards, 6 and 11 causes general awards. And then those in the teens and in the thirties, right? Like, 16, 18, those in the thirties, those tend to cause cervical cancer, right? And remember, the screening guidelines, right? To essentially, you can give, sorry, the vaccination guidelines. Because that given the vaccines, it's the age of nine. These days, on Mbimmy exams, right? So that's just one of those things you want to file away in your memory. And remember, the general awards, right? They are called condinoma conlunata. Please, one makes it up with condinoma lata. Remember, condinoma lata is like the secondary, it's one of the findings in secondary syphilis, right? Just one of those things, again, you don't want to mix up on your test. And the mechanism behind HPV16 and 18 causing problems is they express these proteins called E6 and E7. The thing is, your friends at the Mbimmy love E6 and E7 for cell biology correlates that they have.

The thing is, E6 is actually a ubiquitin ligase, right? So remember, a ubiquitin ligase will put a ton of, sprinkle a ton of ubiquitins on something. And then when you put all those ubiquitins on something, they're actually targeted to the proteasome for degradation, right? So the thing is E6 in HB5353. Remember, P53 is the thing that's mutated and lived from an eye syndrome. And then E7 in HB5303, right? So the thing is, those two proteins are involved in the G1 to SV's transition. So if those things are mutated because they've been destroyed, right? Essentially, the thing that's going to happen is, at least the protein products, right? So this is almost like a protein level, a smartphone that happens. If the protein products are, put your ubiquitin in effect, destroyed in a produce zone, they're not going to get any effects from those genes because those are actually too much suppressor genes. So you have more transition from the G1 to SV's, like unchecked transition from the G1 to SV's, even if you have like a lot of mutations that are built up, right? And that can cause a lot of problems, lots and lots and lots of problems, right? So don't forget, E6 is a ubiquitin like E7, that's a high-youth thing to commit to memory, for example. And then the hepatitis viruses, right? So all of them are antiviruses with the exception of HB, or HB is a DNA virus. So remember, HB is a pecorna virus, fecal or transmission, doesn't progress to chronic hepatitis.

HB is a hepadina virus, right? So it's a DNA virus. I remember that like hepadina, hep, hepad DNA virus. I don't know if that helps you remember that. Again, sexual contact for the most part, kind of ignore the IV drug use business, although it can be transmitted by IV drug use actually. So it can become chronic and again, it increases risk for hepatocelular carcinoma. So actually the HB vaccine is actually one of those vaccines that have been shown to decrease the risk of cancer, right? That can be a very simple question that your friends at the MBM can actually ask you, right? Excuse me. The HBV vaccine is also, again, one of those anti-cancer vaccines essentially, right? And the thing is, hepis vaccine preventable, right? As I've mentioned, and the thing is, if a fetus acquires it in utero, that fetus has almost like, I think like a 95% chance of progressing to chronic infection. But if a person acquires HB as an adult, I think the chance of progressing from acute to chronic infection, chronic infection is defined by timelines. You have like persistent infection of more than six months. Those people I think have like a 5% risk, right? So you see that there are differences in the rates of progression to chronic infection, depending on the age of the period in life when a person gets the HB virus, right? And if a person is at risk, you know, just give the HBV vaccine and also give the HB immunoglobulin, and again, give those in separate arms, right?

In fact, the HB vaccine is one of those vaccines that kids get before they even leave the hospital, right? And again, if someone has been, because there's this classic MBM question that pops up, if a person has been stopped by a needle, and that needle is, you know, from a patient that has had like HB, if the person is knowing, the person that will stop with the needle, the person is known to already be immune to HB, it only needs to give HB immunoglobulin and then to do anything, right? And they remember HB is a flavy virus, sexual contact, but for the most part, think of IV drug use blood transfusions on your test. Highest risk of progression to chronic infection, so it can cause cirrhosis, it can cause HCC. Remember the HCC tumor marker is AFB, right? Remember AFB is also the tumor marker for the Yoke sac tumor. It's one of those gonadal malignancy, sometimes you see it referred to as the endodermosinus tumor. You can actually treat HCC, you can actually cure these days, with like super expensive drugs, like sofaus buvier, the deepest viral, that stuff, there's many of them, they're like the direct ATIN agents. And I talk about those in my pharmacology podcast for micro. And they have DR, remember the DR have DR for D for dependent, right? It's dependent on HB for infectivity. Essentially it means the HB surface antigen, right? That's a higher thing to know for exams. And HE, right? Ficoloror out. Really bad outcomes in like pregnant women, right?

And again, I've talked about this, have A and E, Ficoloror first last alphabets, whatever's first and last or the thesis of the body. It's kind of gross, I'm not gonna repeat it again. And then the HB serologies, right? So people always find these HB serologies to be a pain to learn, right? So let me just teach you a trick. Now maybe I hope you're going through like 99% of the questions, without memorizing too many things. Basically if your HB surface antigen is positive, you have infection. That's it. If your HB surface antigen is positive, you have infection. That's it. The second rule is, if your HB surface antibody is positive, you don't have infection. I'll say that again, if your HB surface antibody is positive, you don't have infection, right? So the two rules, rule number one. If your HB surface antigen is positive, you have infection. If you have the antigen, it means you have the bog on the inside of you. You have infection. If the antibody is positive, you don't have infection, right? And then if you go off of that, you can usually reason out the rest of the stuff pretty easily, right? So for example, if you notice that, oh, a presence of HB surface antigen is positive, and then the HB core antibody is positive, right? And you notice that, oh, it's IgM. You know it's an acute infection. The fact that the HB surface antigen is positive means there is infection. The fact that the HB core antibody is positive, and it's IgM means it's acuity infection.

If it's IgG, it's chronic infection, right? But if you notice, if you get a question like, oh, the HB surface antibody is positive, it means no infection. Well, if you check, and the core antibody is positive, it means the person was infected before I recovered. But if the core antibody is negative, it means that the person was never infected, and the person was just vaccinated against HB, right? And then the other one, weird one, where it's just the core antibody is that's positive, like the surface antigen is negative, the surface antibody is negative, that's the window period, right? That's pretty much it for the HB serologies. If you just follow these rules, you don't have to memorize much. There is just, mix your life like super easy on exams. And then the HB virus is right. So let's kind of talk about these real quick, right? So we have like HHV1, that's HSV1, right? Causes herpes, like LBLS, so like oral herpes. It could also cause genital herpes as well, right? So don't completely hold that to her. That, oh, the mind said that HHV1 only causes oral herpes. That's not true. You can also cause genital herpes. In fact, NVM equations have been known to show up where it was a genital herpes question and the core antibody was HSV1. But it input HSV2 as an answer, right? But basically, HSV is what causes oral or genital herpes. And the HSV2, again, is the most common cause of genital herpes. But again, remember, it could also cause oral herpes.

And then HHV3, that's VZV, that's virus salad, right? Causes chickenpox in the primary childhood infection, shingles for the older individual, right? Remember, the neuropathic pin from shingles, you can kind of treat it with tricyclic antidepressant, or you can use like gabapentin or pregabaline, right? And again, a buzz word, you people have like pain and vesicles in a bromo distribution. You see that think about HHV3. And then HHV4, that's EBV, right? Causes mono, right? Causes infectious mono-neucleosis. The higher your history, be a young person. I don't have never seen old people on NVM's get EBV, right? Because old people on NVM's, I'm not saying the real world, but on NVM's, classically, they're not participating in like risky sexual behaviors, right? So if you see a sexually active young person has cervical lymphodonopathy, soft throat, and the cervical lymphodonopathy, don't just be fixated on, oh, it's got a people's theory. It can actually be anterior on an NV Me, right? So if you see a young person with lymphodonopathy, soft throat and spleen omega-le, that's an EBV on your test, right? And the thing is, the virus remains related in B cells, and it gets in through CV21 in two cells, right? So the thing is, because it infects B cells, right? It's a virus that's infecting cells, you'll tell me that the immunity will try to act against it, right? So you have a proliferation of atypical T cells, right? They're called downy cells.

They are CD positive when a blood smear, right? And again, it remains leaf-ent in B cells, right? And remember that it causes a monospot positive, a mononucleosis syndrome. Those people need to avoid contact spots for a while, so they don't like rupture their spleen, right? The reason why their spleen's distant is because, again, the periodic trill lymphatic sheath, the pulse region of the spleen expands, right, to proliferate those downy cells, right? So they again, they can ask you the mechanism behind the spleen or megalith, that's one thing you want to keep in mind on your test. And the HHV5.CMV, right? It tends to be transmitted through like renal transplants, blood transfusions, you can also transmitted in utero, right? So if you get a question about an infant that has like hepato megalith, has a blueberry muffin rash, and then here's the caustic superhiolthid, for example. Peri-ventricular calcifications on imaging of the brain. If you see that, stop reading the question, that's CMV. And remember, it can also cause like colitis or hypnitis in like HHV patients, or again, like post-transplant recipients, right? And now people may see the one you're seeing recipients. That's actually how it's pronounced. It's not pronounced as recipients. Recipes, it's actually the wrong pronunciation. That's one of the things I'm actually pretty good at, pretty good at English. Okay.

And again, the virus remains to live in like your mononucleosis system, and it causes a monospot in negative. Mononucleosis like syndrome. And the HHV6 was already talked about that. That's exempt them, so that's six disease. And then HHV8, Kaposis or coma, right? Remember, look up pictures of Kaposis or coma online. That's a classic thing. They then to put on exams, right? And then, again, most viruses, they get the envelope from the cell membrane where remember herpes gets its envelope from the nuclear membrane. So again, that's kind of high up to no for exams. So let's just run through some quick triggers to kind of wrap this up. So now run through these. And again, you don't need to write these down. The answer is on the following slide. Well, let's run through these real quick. Just use these to quiz yourself. So a rash with a slug chick appearance, right? That's a, that's a bubble B19, right? Cove cariza conjunctivitis plus couple of spots that's measles, right? A descending maclopopular rash that's also measles, right? Gasoline Riders and eventual paralysis, that's polio, right? Remember polio is one of those interrog viruses. If you see cervical cancer in the sexually active, that's HIVV16 and intine. Paratitis or chidis and nil sterility, that's the month's virus. So I remember it's a live at the Nithyan virus. If you see cataracts and blindness in a newborn, right? Think about a rebella.

Remember, rebella can also cause like a p-thin doctor's arteriosus as well, right? So that's like the congenital rebella syndrome. And then if you see like pin-four skin lesions in a dermatomopartor, that's HHV3, right? That's a varicella, zoster virus. Virus that remains dominant in the doso organ, that's also VZV. It might be in an AIDS patient, that should be what? CMV, I hope you're saying that. And don't worry, I'll be done with this podcast pretty quickly because after a run for a meeting, pretty soon. Genital warrants, right? That's HVV6 M11. Pin-four vesicles on the genitals, that's HHV2, right? But it could also be HHV1. Hepatitis is a pregnant woman with high mortality. That's hep, e, okay? And then gastroenteritis and cruise ship, that's the virus, that's normal virus, pretty easy. And then fatigue, spinoe, megalian, etico, etypical lymphocytes on a blood span, a young person, that's EBV, that's HHV4. Chalkal gastroenteritis, remember, that's the only double-stranded RNA virus, that's rotavirus, right? And then two common causes of the common code that's coronaviruses and rhinovirus. And rhinovirus is the most common broken lightest in an infant, that's RSV, right? Second phase genome plus epidemic shift pneumonia, that's the influenza virus, right? And then animal bi-plus fatal infected light is that's rabies, and then influenza light is in the new units.

There's many things, but you know, it can be like HHV, especially when they have like blood CSF, like CSF that has like a crap ton of red blood cells. And then, next one, so 75-year-old man has been evaluated for a 3-D histroproductive cough, fever, and chills. The medical student on service collects some of the patients rust-colored flam, for evaluation prior to beginning and period treatment. Physical exam reveals a febrile patient with a temperature of 100 degrees, 103 degrees far in height. And crackles in the right lower posterior lung field, which of the following best explains a key virulence factor associated with the offendin organism. So what do you think the answer is? So what bug am I referring to here? It's struck me more, right? Remember, struck me more really torches like mucus or surfaces, like respiratory mucus. So it makes sense that you should have like an offensive weapon against the antibodies that guides your mucus. In this case, IgA, right? So it has an IgA prodigies, right? Remember, Ig is a dimer, right? So the answer here is option D. Remember, this is just one nice way that the NVME can integrate immunology and microbiology. Do you love to make those integrations on exams? Okay, and again, struck me more chiddles of tracks. So remember, it's a third gen cephalospory. So I'm going to keep going. And then, other quick questions here, right? So, you know, an adrenaline cephalitis from a mom that handles cats.

I'll be thinking about like toxoplasma, right? Bloody diars from undercooked chicken. And then, you know, it's a Campalobacteria juno, right? It's the most common cause of bloody diary in the US. Like, you know, infectious cause of bloody diary. Remember, it can also cause the ombre syndrome, right? And then, higher loronic acid capsules, M protein, right? That's strep pyarginis, that's group A strep. And ataxia loss of sensation in a sexually active female, right? Ataxia loss of sensation. You know, maybe think about cephalus, like TBS or salis, to share your cephalus. And cephalitis weeks after consuming undercooked pork. That's like neurosis or causes from my teenia solium. And then, CT scan shows rink enhancing lesions in the brain of HIV patient. That's toxoplasmosis as well. If you see a single lesion, it could be toxop, but it could also be a primary CNS lymphoma. Bloody diary and hepato mechali. I can liver abscess. And let's say the tell you that this liver abscess has an anchovy paste, consistency. That's intamibahistolinica. Remember, that is strideomachronidazol. And then, every steaming the stool sample of an AIDS patient, like diary and an AIDS patient, that's cryptosporidium. I remember you can treat that with paromomycin or nitazoxamine. And then, sexually active meal with arthritis and skin pitichii. That's going to be rare. That's pretty easy. I inflammation of the testicles and parodids. That's the mom's virus. Sequo cell patients, super low hemoglobin.

Think about parvobe 19, etplasty presses. Right? And then, permanent flasy paralysis in an on-vaccinated child, maybe from California. Or like some West Coast state. Sorry. It's just again a classic presentation. Think about polio. And then, no courageility in a two-week-old child. That'll be group B-strap. Remember, group B-strap or strippy can acte is the most common cause of any notable infection in the first 20 days of life. And then, most common bacterial cause of ST Ds in the US is what? It's chlamydia. Right? And then, most common cause of UT Is in the US is E coli. Second most common cause. I hope you know it's staphsaprophidicus. Right? And there's this bug here. Plus, when you're related to com, that the indian is beginning to care about. So kind of like, make sure you know about that. It's a ureuse positive box, so you can cause like, it can cause many things like prematurely brain delivery. It will cause a UTI with like a super high urinary PE. So you can cause those provide stones on tests. But it's not here. I don't mention it here. I think I mentioned it earlier or something. And then, elevated liver enzymes in a pregnant woman that subsequently dies, that's hep E. Right? And then genetic property, associated with a worldwide influenza epidemic or pandemic, that's like reassortment. Viral conjunctivitis, like, firingoconjunctivitis, that's abno virus. Black escharinobabetic, that's a, that's actema that renal stuff, that's going to be pseudomonas.

Viral myocarditis, that's coxac-yb. Remember coxac-y-a is hand-forth mouth disease. And then flu-like symptoms after visiting Hawaii's leptospiroces, right? So leptospirin, teradans, remember it's a spirochete, so you can see pretty well on the dark throat microscopy. And then, final question here, and then we're done. So, cellulitis and a burnt patient, remember that bug, that gram negative that loves wet environments, that's pseudomonas. Bows ira-asch, right? That's, that's borelia, borgdophore, that's, that's lime disease. Strawberry tongue, that's triapyology, that's chale fever, right? Strawberry cervix, right? Strawberry cervix is, um, common domain thing, it's, um, tri-commonas vaginalis, right? Oops. There after returning from Mexico and drinking water, right? So, travelers, diarrhea, montezuma, revenge, that's enterotoxyginic e coli. And then, maclopapular rash, a few weeks after returning from spring break. So, think of maybe like, you know, maybe it's arachnopoms and souls, it can be like secondary syphilis, you know, stop people growing spring break. Again, I'm just, mostly never one knows that, that stuff on spring break, but you know what I mean? Fever no core rigidity, alter mental status, you know, maybe think about it, I assume it's ingeridis. meningitis and a college student, right? That'll be nice, you're meningitis. Next best step in the management of a patient with no core rigidity.

If they don't have signs of increase in chocrenial pressures, you can strongly consider, um, um, getting like, um, a lumber puncture, right? Well, you do a CT scan first, if you have signs of increase ICP, because if you do a lumber puncture in a present with high ICP, you're going to need a diet and that's no idea, right? And they meningitis and an older individual think about stripping them all. meningitis and an unimmunized infant, um, um, uh, think about, I don't know what I was thinking about with this question. Oh, yeah, I'm already sure what I was thinking about there. And then drop of choice in the future, my seromyinjididis, that's the tetraaxum. And they meningitis and an neonate that's going to be ruby stripped. Apparently I was thinking about like, I'm assuming meningitis or HMF, yeah? Because those are both a vaccine preventable. So I'm going to go ahead and stop here as I do at the end of every podcast. I do all four. I want to learn from many exams step one, two CK, two CS, step three, preclinical, medical exams, 30-HLF exams. Um, if you're medicine or a pizza resident, like your intra-inxymoid or bored exam, of a tiering for all those things, um, if you're a college student, a new student for like the pre-med subjects, Genk-Kem, O-Kem, physics bio-chem, histology, physiology, um, basically the MCAT subjects are a tier to those.

And then if you're a college student, I'm planning to med school so like an AMCAZ app, or a mentioned I'm planning to like, residency so like an ERAS app. I'm a doctor like one on one advice, you know, you can call it coaching for those exams. Um, and again, many of the people have worked with you. They've been like super, super successful. For the most part, they've pretty much all much that their first choice is. And then I also offer these booster courses. It's 15 hours for step two, CK and step three and 20 hours for step one. So if you're interested in that, just reach out to me. Essentially, it's a Q&A very rapid review, most no clinical presentations for these exams. And again, the vast majority of people have done this thing with. They found it to be super helpful. And then one other thing I will say is, um, please subscribe to the podcast app. You can find the pot, I mean, to the podcast, it's an Apple podcast, Spotify, Google Play. And also please subscribe to my, to this You Tube channel. So thank you for listening. I really appreciate it. The life lesson I want to give you today is, um, essentially just being a hard working person, right? Hard work is called hard work for reason, right? But the thing is, if you work hard and you're willing to deliver identification, success is possible. But if you're an instant gratification person, you won't look towards the future in the things you're doing. Right? So don't concentrate on the present.

Don't just give up like your future crown for like some present enjoyment. Right? So if you know you have a step on coming up a year from now, stop preparing for that exam. Because the way you perform that exam kind of determines a pretty big chunk of your future as a medicine as a person in medicine. Right? So I hope you take this lesson to heart. I hope you find it to be helpful. I'll see you in the next podcast. Thank you for listening. God bless you.

Rotavirus (a double-stranded RNA virus).

Hepatitis E Virus (HEV).

Cough, Coryza, and Conjunctivitis (the "three C's").

Rubella virus (or Measles virus, depending on context, but Rubella is often tested for its specific spread). Correction based on transcript: The question refers to measles having a descending maculopapular rash.

Oral Polio Vaccine (OPV) is live-attenuated; it is contraindicated in immunocompromised individuals or pregnant women due to risk of vaccine-derived pathogens.

Parvovirus B19.

Shift involves major reassortment of entire genome segments (causing severe pandemics); Drift involves point mutations (causing less severe epidemics).

Negative-sense single-stranded RNA viruses.

E6 (a ubiquitin ligase) and E7; they degrade tumor suppressors p53 and Rb, respectively, leading to unchecked cell cycle progression.

It travels via retrograde axonal transport along peripheral nerves back to the CNS (motor neurons).

Measles virus.

Blueberry muffin rash, megaloblastic anemia, or periventricular calcifications on brain imaging.

Acute Hepatitis B infection (H BsAg = current infection; Anti-H Bc IgM = acute phase).

Hydrops fetalis (or aplastic crisis leading to heart failure/edema).

Negative-sense single-stranded RNA viruses.

E6 (a ubiquitin ligase) and E7; they degrade tumor suppressors p53 and Rb, respectively, leading to unchecked cell cycle progression.

It travels via retrograde axonal transport along peripheral nerves back to the CNS (motor neurons).

Measles virus.

Blueberry muffin rash, megaloblastic anemia, or periventricular calcifications on brain imaging.

Acute Hepatitis B infection (H BsAg = current infection; Anti-H Bc IgM = acute phase).

Hydrops fetalis (or aplastic crisis leading to heart failure/edema).