How is HSV 1 transmitted? -saliva How is HSV 2 transmitted?

-sexually During the latent stage, where does HSV 1 hide? -trigeminal ganglion Where does HSV 2 hide? -lumbo-sacral ganglion Where do HSV 1 lesions show? -above waist (vesicular) HSV 1: Signs and symptoms Gingivostomatitis in children fever & vesicles -HSV1 Herpes labialis - Cold sores in muco-cutaneus junctions (i.e. junctions between skin and mucous membrane) - HSV1 In eye it produces corneal ulcers HSV1

In Brain: encephalitis (temporal lobe necrosis) head ach vomiting and altered mental status HSV1 Can cause blisters in fingers -(herpetic whitlow) -HSV1 Drug of choice for HSV? -acylovir Primary disease of herpes zoster? -chicken pox

Recurrent lesion of herpes zoster? -zoster (shingles) How is herpes zoster transmitted? -airborne water droplets (respiratory tract) How does herpes zoster spread? -blood through skin After recovery, where does herpes zoster become latent? -DRG zoster is painful vessels along which spinal nerve? -trigeminal Treatment for herpes zoster? -none What may using asprin with herpes zoster produce? -ryes syndrome (encephalophy and liver damage) Herpes zoster vaccine? -yes (live) CMV causes mainly what in children? -mental retardation CMV spreads (children)? -saliva CMV spreads (adults)? -semen/ cervical secretions CMV spreads (pregnant) -placenta/ breast milk/ birth canal CMV symptoms in adults and children? -asymptomatic What part of the stages of pregnancy will mothers transmit CMV causing congential anomolies such as small head? -1st trimester Treatment for CMV? -gancloyvir -fascornet

Treatment for retinitis? -fomivericin What can CMV cause in AIDS patients? -retinitis Causes infectious mononucleosis? -epstein barr virus How is Epstein barr virus transmitted? -saliva Where does infection occur (region of body)? -oropharynx Where in the body does Epstein barr infect? -epithelial cells of oropharynx infects B lymphocytes What WBC attacks infected B lymphocytes? -cytotoxic T cells What is the result of this? -enlarged, distorted B cells (Downey cells) Treatment of Epstein Barr virus? -NIL Transmission of small pox? -airborne respiratory droplets What is moluscum contagiosum? -small pink colored tumors How long are the tumors present before they disappear? -one month How is moluscum contagiosum transmitted? -close contact (common among children) How is moluscum contagiosum removed? -electrocautery -liquid nitrogen Type of virus (influenza)? -orthomyxovirus

What does the orthomyxovirus interact with? -myxo =mucin (glycoprotein) Influenza virus shape and construct? -SS RNA genome helical capsid with outer lopoprotein envelop Two type of spikes on the influenza envelop which determine type specificy? -hemaglutinin -neruaminidase source of influenza A? -humans -birds -chicken -swine -horses Source of influenza B? -humans Transmission of influenza? -air born- respiratory droplets When is infection of influenza most prevlant? -winter months What does inhaled flue virus degrade? -mucous What assists in degradation of the mucous? -neuraminidase What are the systemic symptoms of the flu due to? -circulating cytokines What is the typical resolve of flu (time frame)? -4-7 days What can occur with influenza B and chicken pox? -ryes syndrome What is the treatment for the flu (A and B)? -neuraminidase inhibitors -tamiflu -zanamvir

What is the treatment for flu A? -amantadin Natural host of measles? -humans 2 types of spikes in measles contain? -hemaglutinin -fusional proteins Where does RNA and protein synthesis take place with the measles? -cytoplasm How are measles released? -budding

How are measles transmitted? -respiratory droplets When do the measles become non- infectious? -after development of rashes What causes the rashes in measles? -cytotoxic T Cells attacking the virus infected cells How long are infants protected by maternal Abs? -6 months What is a complication of measles? -encephalitis Type of vaccine for measles? -live attenuated 2 types of spikes on one envelop of mumps? -hemaglutinin and neuraminidase -cell fusing and hemolytic activity What is the mode of transmission of mumps? -respiratory droplets When are the mumps most prevelant? -winter

Complication of mumps? -orchitis in post pubertal males- infertility -meningitis- child What is the lab diagnosis for mumps? -saliva culture What does respiratory syncitial virus cause in infants? -pneumonia -bronchiolitis What are the natural hosts of respiratory syncitial virus? -humans -chimps What is the mode of transmission for respiratory syncitial virus? -respiratory droplets -direct contact with nose and mouth by finger What is the age everyone is infected with respiratory syncitial virus? - age 3 In infants, where is the more severe area effected (respiratory syncitial virus)? -lower respiratory tract What clinical features does respiratory syncitial virus present with in small children? -bronchiolitis pneumonia -ottis media -fever -rales What are the clinical features respiratory syncitial virus presents with in adults? -common cold symptoms What is the lab test used to detect respiratory syncitial virus? -immuno fluorescence What is the treatment of respiratory syncitial virus? -aerosolised ribovirin (virozol) -hyper immune globin What does the para influenza virus cause in children? -CROUP

What is the mode of transmission of para influenza virus? -airborne droplets What are the 4 types of para influenza virus and what does each cause? -type 1- croup -type 2- croup -type 3- LRI -type 4- common cold What does rubella virus cause? -German measles G+ve or G-ve- Rubella virus? -G+ve What surface spike does Rubella virus contain? -hemaglutinin Where does replication and assembly of the Rubella virus occur? -cytoplasm How is the Rubella virus released? -budding What is the mode of transportation of Rubella? -respiratory droplets -transplacentaly from mother to fetus Length of time of rashes in Rubella? -3 days Length of rash on body in Rubella? -maculo pauplar rashes from face to trunk and limbs Shape of rabies virus? -bullet shaped G+ve or G-ve- Rabies? -G-ve Where does Rabies attach to? -Ach receptor site Where does Rabies replicate? -cytoplasm

What are the hosts of Rabies? -mamals -skunks -raccoons -bats -dogs What is the mode of transmission of Rabies? -non bite through respiratory aerosol -bat secretion Mode of pathogenesis of Rabies? -axonal transport to CNS- multiplies in brain tissue- spreads through peripheral nn to salivary glands In regards to Rabies, what are eosinophilic cytoplasmic inclusion bodies seen in neurons? -Negri bodies In rabies, can encephalitis develop in the CNS? -yes What is the prognosis of the pt with Rabies? -painful spasm of throat mm during swallowing -comma and death How can Rabies be diagnosed? -flourescent Abs staining of biopsy from skin on neck (hair line) -isolation of virus from saliva What is the name of the Rabies virus? -human diploid cell vaccine DNA non enveloped virus ? -adeno virus -papilloma virus -parvo virus transmission type of parvo virus? -aerosol -fecal/ oral -direct inovulation into the conjunctiva Where does a latent infection of the parvo virus occur? -tonsils -adenoids

Cause: Serotypes 3,4,7, 21 -respiratory disease 8, 9 -epidemic karato conjunctivitis 11, 21 -hemorrhagic cystitis 40, 41 -gastro enteritis Pathogenesis of adenoviris? -mucousal epithelium of respiratory tract, GIT, conjunctiva What adenovirus serotypes is there a vaccination for? -4,7, and 21 What does HPV cause? -warty growths from squamous cells of skin What serotypes are skin warts caused by? -HPV 1 -HPV 4 What serotypes are genital warts caused by? -HPV 6 -HPV 11 What serotype is associated with carcinoma of the cervix/ penis? -HPV 16 What is the mode of transmission of HPV? Skin to skin -gential contact What are the most common STDS? -genital warts Type of patient with a very high rate of carcinoma cervix? -HIV What does parvovirus B19 cause? -Erythema infectiosum (slapped cheek syndrome) What is the smalles virus?

-parvovirus What is the mode of transmission of parvovirus? -respiratory -transplacental 2 types of cells that parvovirus infects? -premature RBC s (erythroblasts) -endothelial cells of bv s Antibody complexes seen in parvovirus? IgG IgM What does the parvovirus cause? -arthritis

How does the parvovirus present in children? -slapped cheek syndrome How does parvovirus present in patients with sickle cell anemia? -aplastic anemia What does parvovirus infection in 1st semester of pregnancy result in? -death What does parvovirus infection in 2nd semester of pregnancy result in? -hydrops fetalis What is the method of diagnosis of parvovirus? -IgM detection -PCR to demonstrate viral DNA Treatment of genital warts in parvovirus? -podophylin Treatment for skin warts in parvovirus? -liquid nitrogen Treatment for plantar warts in parvovirus? -surgically -salycitic acid Type of interferon effective in the treatment of parvovirus? -alpha interferon

Virus causes red eye? -adeno virus What is fifth disease? -virus leads to rash on cheeks, arms and legs -caused by parvo virus What is the host of polio virus? -primates -humans Transmission of polio? -fecal/ oral route Where does polio replicate? -oro- pharynx -intestinal tract What immunoglobins respond to polio? -IgA -IgG What is the pathogenesis of polio? -blood CNS infects motor neurons (ventral horn SC) death of motor neurons paralysis How long will the pt excrete polio in feces? -6 months What anti- viral drug is made for polio? -none What are the two types of polio vaccines? -killed vaccine (salk)- IPV -live attenuated (sabin) oral In the US, what is the only vaccine given? -killed vaccine (salk)- IPV Group A coxsackie virus infects where? -skin and mucous membrane Group B coxsackie virus infects where? -internal organs

What is the mode of transportation of coxsackie? -fecal/ oral route Where does coxsackie replicate? -oropharynx -GIT What season is coxsackie most common? -summer

Matching: -Herpangia- fever, sore throat And vescicles in oral cavity -Acute hemmoragic conjunctitis -Foot and mouth disease -Pleurodynia -Myocarditis and pericarditis Rhino virus causes? -common cold Hosts of rhino virus? -chimpanzees -humans Where is the rhino virus infection confined to? -nose Ig produced in regards to rhino virus? -IgA Transmission of rhino virus? -aerosol Group A

Group A Group A Group B Group B

-hands -fingers -towels Used to treat rhino virus? -high doses vitamin C -Zn gluconate Mode of transmission of reo/ rota virus? -fecal/ oral route Where does reo/ rota virus replicate? -cytoplasm What are the clinical features of reo/ rota virus? -gastro enteritis in children -watery diarrhea Jaundice causing viruses? -HAV -HBV -HCV Hepatitis A- RNA or DNA/ Enveloped or non- enveloped? -RNA non enveloped Where does HVA replicate? -cytoplasm Mode of transmission of HVA? -fecal contamination of water Resivoirs of HVA? -humans Most affected by HVA? -children Pathogenesis of HVA? -liver cells causing cell necrosis HVA damaged liver cells, repairable or not? -fully repairable HBV- DNA or RNA virus/ enveloped or non enveloped? -DNA envelop

HBV is also known as? -Dane particle -hepandna virus Mode of transportation of HBV? - blood Area of the world which HBV is most prevelant? -south east Asia Area of the world hepatocellular carcinoma is most prevelant? -southeast Asia Treatment of HBV? -alpha interferon -lamivudine HCV- RNA or DNA/ enveloped or non enveloped? -DNA enveloped Resivoir of HCV? -humans Transmission of HCV? -blood transfusion (IV) Infects hepatocytes? -HCV Enhances risk of HCV? -alcoholism HBV or HCV- milder for jaundice features? -HCV Athralgia, vasculitis and purpura occur in this virus? -HCV Lab detection of HCV? -ELISA What detects RNA s in HCV? -PCR What hepatitis virus has elevated levels of transaminase?

-HCV Treatment for HCV? -alpha interferon -ribavirin -pegylated interferon- long acting HIV and HCV co- infection should be treated with ? -HAART HCV co- infection with HIV reduces or increases mortality rate? -decreases Arthropod born virus? -arbo virus What is known as eastern/ western encephalitis? -arbo virus Three types of arbo viruses? -west nile virus -yellow fever -dengue West Nile virus infects? -birds Spread of West Nile virus is by? -mosquito bites Yellow fever is spread by? -mosquito bites Virus with symptoms of: jaundice, fever, hematemesis (vomiting of blood)? -yellow fever Dengue is spread by? -mostquito bite Known as break bone fever? -dengue In hemmoragic form, dengue bleeding occurs where? -GIT -skin *becomes fatal

SEE PRINTED OUT QUIZ FOR HAND WRITTEN Q AND A FROM QUIZ 2 Retroviruses? -HTLV -HIV Cells HTLV/ HIV infect? -CD4 T cells Type of effect of HTLV on CD4 cells? -immobilizes Type of effect of HIV on CD4 cels? -kills Type of regulator gene function of HTLV: -Gag o core protein -Pol - enzymes -Env -envelop proteins -Tax -transcription activator -Rex -mRNA synthesis and transport to cytoplasm Capsid protein of HTLV? -P24 Env proteins of HTLV? -Gp 46 -Gp 21 How is the RNA of HTLV released? -budding Transmission of HTLV? -IV drugs -sexual contact -breast feeding Two diseases HTLV produces?

-ATL - Adult T cell leukemia -HAM - associated myelopathy (demylenation of motor neurons in sc) Type of HTLV disease: common in middle aged women- gait disturbances, weaknesses of lower limbs, loss of bowel and bladder control, loss of motor function (like MS) -HAM Treatment of ATL? -chemotherapy Treatment of HAM? -corticosteroids Shape of HIV? -bar shaped core surrounded by envelop w/ glycoproteins HIV- DNA or RNA? -2 copies of RNA in center Core protein (gag) for HIV? -P24 -P17 Replication process of HIV: y attachment to CD4 entry uncoating reverse transcriptase (RNA genome to proviral DNA in cytoplasm transported to nucleus intesgrase unites proviral DNA to host DNA host cell RNA polymerase transcribed proviral DNA to mRNA How is HIV released? -budding How is HIV transmitted? -sexual contact -blood transfusion -perinatal infection What is the main immune resistance to HIV? -cytotoxic T- Cells (CD8) Autoimmune disease which may result from HIV infection? -thrombocytopenia Diagnosis of HIV?

-ELISA What is first detected in the pt s serum? -anti p24 What is used to confirm HIV? -western blot test Treatment of HIV? -ziduvidin -lamivudin -indinavir -HAART

Common infections of AIDS patients? -pheumocystic carni -kaposi s sarcoma -herpes simplex -vzv -CMV -candidia -crypto meningitis -hisplasma capsulatum -toxoplasmosis -tuberculosis What are cestodes? -tape worms What are trematodes? -flukes What are nematodes? -round worms What are metazoa? -multicellular parasites What are the 3 metazoa (multicellular parasites)? -cestodes -trematodes -mematodes

What are the two parts of tape worms? -scolex (suckers) -proglotis (flat body mult segments What produces eggs? -terminal proglotids What eats proglotids? -cattle/ fish What happens to the eggs excreted? --lodges in mm of cattle Is man a host of tape worms? -yes 4 types of tape worms? -pork -beef -fish -dog Pork tapeworm is known as? What does it cause? -taenia solium -causes cysticircosis (disease) eggs passed in feces eaten by pigs embryo hatches reach skel mm-> develop into larval form (cysticerci) eaten by man (definitive host) How long does it take pork tape worm to grow? -3 months How long does it get? -5 meters long If a human has poor personal hygene, where may cysticerci develop? -brain and eye What may cysticerci in the brain mimic? -brain tumors What may cysticerci cause in the eye? -uveitis -retinitis

What is the effective drug for adult worms? -parziquintal What is cysticercosis treated by? -surgical excursion Beef tape worm (taenia saginata) Where is the beef larvae developed? -small intestine How long does the beef tapeworm grow? -10 m What detach and passed in stool? -gravid proglotids What is a definitive and then intermediate host of beef tape worm? -humans/ cattle What is the treatment of beef tapeworm? -praziquental What are clinical manifestations of beef tape worm? -asymptomatic -prostaglotis may protrude through anus Fish tapeworm (diphylobothrium latum)

How long does a fish tapeworm grow? -13 m What are the two intermediate hosts of fish tape worm? -crustacea -fish How are eggs passed from fish tape worm? -contaminated water What manifistations does an adult fish tapeworm produce? -asymptomatic -anemia due to B12 deficiency What do dog tape worms (echinococcus granulosus) cause? -hydatid cyst in humans

What are the intermediate and definitive hosts of dog tape worms? -dogs definitive host -sheep intermediate host -humans dead end intermediate host How many eggs do worms liberate in dogs? -thousands Where does the embryo of dog tape worms emerge? -intestine Where does the embryo of dog tape worms migrate? -liver -lung -bone -brain Where does the embryo develop? -large fluid filled hydatid cyst When is the liver cycle completed in a dog tape worm? -when sheeps livers containing hydatid cysts is eaten by dog (in slaughter house) How are dog tape worms removed? -surgical What is used to kill scolices to prevend accidental dissemination of dog tape worms? -hypertonic saline injection What are the three types of flukes (trematodes)? -blood flukes (schistasomes -liver flukes (clonorchis sinensis -lung flukes (paragonimus westermani) What does a life cycle involve? -sexual cycle (in humans -asexual reprod (reshwater snails- intermediate host) What is transmission of flukes occur in humans? -penetration of skin by free swimming larval form (cercaria)- most common -ingestion of cysts 3 species of schistosoma and where they infect -s. mansoni- git -s. japanicum- git

-s. haematobiumWhere do s. mansoni and s. japanicum live? -mesenteric vv draining intestine s. hematobium live? -pelvic vv draining bladder size of adult worm? -1-4 inches What types of water does human infection occur? -fresh water (ponds/ lakes) What shape tail do they have? -fork tail Where on the human do they penetrate? -legs clinical manifestation of schistosoma? -asymptomatic -eggs cause granulomas in liver- portal hypertension w/ enlargement of l liver and spleen -damage walls of colon and sm intest- gastron intest bleeding -granulomas in blood- hematuria Liver flukes reside? -liver Lung flukes reside? -lungs Drug of type for all worm infections? -praziquental What does the body of the worms have to coat and protect? -cuticle (acellular) M/ F- which coating is larger? -female What is the intermediate host? -none What is the host?

-human What do these cause? -eosinophilia -allergies -disease What is a thread/ pin worm known as ? -(enterobius vermicularis) What happens to the male after fertilizing the female in a thread worm? -dies What happens to a fertilized female? -migrates to anus in the night lay eggs in perinatal skin and in enviroment eggs hatch in 6 hours- become infectious Where do the eggs begin, migrate and hatch? -intestin to colon What is the clinical manifestation of pin/ thread worms? -perianal pruritus -scratching (common in children Treatment? -mebendazol -pyrental palmoate (reeses pin worm med) What does the treatment drugs act on? -on adult worms (not on eggs) How often must the medication be repeated? -2 weeks What is the lab diagnosis method? -perianal scrapings (scotch tape) (NOT STOOL) How does human infection occur in round worms? (full process) -soil contaminated with human feces- hatch in sm intest- larvae spread through blood to lungs- enter alveoli, bronchus and again swallowed- become adult worm Where do round worms live? -intestinal lumen What do roundworms live on (sustinence)?

-ingested food How big can intestinal nematodes grow? -25 cm + Clinical manifestation of roundworm? -eosinophilia -chronic bronchitis -cough -malnutrition Where are roundworms common? -warm climate lWhat are known as hook worms? -ankylostoma duodenale -necator americanus How does the hook worm work? -attach to gut wall- suck blood- produce anticoagulants- major loss of blood producing microcytic anemia Where do hook worm eggs develop? -soil What is the intermediate host? -none

How are hook worm filariform larve penetrated and spread to? -skin of feet and legs -blood, lungs, alveoli, bronchus, trachea. If swallowed- sm intestine Clinical manifestiation of hook worms? -anemia -pallor -weakness -pruritic patch at skin entry (ground itch -pneumonia with eosinophilia (during larval migration) Lab diagnosis? -stool exam Treatment -mebetazol and pyrentol

Most common resivoil or trichenella spiralis? -pigs How are human infection occur? -eating undercooked prok containing larvae Are larvae passed in stools? -no larvae sccyst- develop in adult worm in mucosa of small intest- eggs hatch- larvae released- distrib to skep mm Maintained in nature between? -swine and rats Clinical manifest -diarrhead -fever --eriorbital edema -esioniphilia READ PAGE TO SEE WHAT MISSED Only host of W. Bancrofti? -humans How W. Bancrofti is spread? -female mosquito bites and deposits infective larvae on skin

Where to the larvae migrate? -lymph nodes How long does it take to mature to adult worm and what does it produce? -1 yr -microfilaria (circulate in blood to become infective -mosquito bits and ingests and repeat Manifestations? Inflammation -obstruct lymph drainage- edema -fever lymphangitis cellulitis chills

Chronic causes lead to? -edema fibrosis of legs and scrotum CHECK LAST THING Treatment? -Diethyl carbomazine- microflairae- not worm What is onchocerca volvus cause? -river blindness How is it transmitted? -black fly bite on skin causing dermal nodules Definitive host? -humans Where are the adult worms located? -inside a dermal nodule Clinical manifest? -inflammation in subcut tissue prod pruritic papule / nodule -wrinkeled skin -thickening scaling dryiness (lizard like skin concentrate in eyes- blindness

Lab diagnosis? -biopsy of affected skin show microfilarae treatment? -ivermycin (microfilaria -suramin adult worms surgical- skin nodules Guinea Worm- dracunculus medinensis X (guinea worm)- graph it out Manifestations? -ulcers in food (head of worm in ulcer can be seen) How does one have the head come out of ulcer? -immersed in water

Treatment? -worm extracted slowly over a period of days -thiobendazole -metronidzole (tranquilizes the worm) Toxocara canis (liver causing disease) causes? -visceral larva migrans Host? -dog How is this spread? -feces to soil Larvae hatch and migrate? Man intesting- migrate to lung liver brain and eyes How do they die? -encapsulation and die on own What is the accidental dead end host? -human Why does a granuloma form around dead larvae? -delayed hypersensitiviey in resp to larval protein Symptoma? -fever -eosinophilia -hepatomealy Complication? -blindness Common in? Children in uz Treatment -Albendazol -mebendasol Parasites are what type of cell? -eukaryotes Intestinal protozoan -entamoeba histolitica

-giardia lamblia urogentital protozoan -trichomas vaginalis blood and tissue protozoan -plasmodium -toxoplasma -trypanosma -leishmania Dysentary/ diahrrea -E. Histolytica Liver lung abscess -giardia lamblia Mode of infection -oral fecal rout- contaminated food and water What is seen in non diahrrea stool? -cysts Teatment for all protozoal infection? -metronidazol Trichommonas vaginalis trnsmission? -sexual

Found? -mostly prostate -also vagina Symptoms? -white discharge (leucoria) Herpes simplex treatment? -acylovir Clinical manifestations of herpes simplex? -blisters Where is it dormant? -DRG of trigeminal nn (blisters in face) (mandibular most involved)

Herpes zoster dormant? -DRG of ophthalmic branch CV V varicella zoster (herpes)- chicken pox What is amantadin? -antiviral of flu (uncoating of capsular protein) Tamiflu? -prevention of flu Commonest cause of blindness in children in US? -toxoplasmosis What is cysticircus? -larval form of tinea soleum How is this acquired? What is thread worm? -same as pinworm What is intermediate host? What is the Rx? -

What is leucorrhea? Which viral disease causes sterility when it affects young adolescent boys? What viral diseas spread through fecal oral route (through water)? -polio -cocksakie (foot and mouth disease) -hepatitis A Which viral disease can get through mostquito bite? -dingo (yellow fever) Which viral disease can get through breathing in contaminated air (airborn viral disease)?

-adeno virus -measles -mumps -most viral diseases Intermediate hosts for parasitic infections (know which disease goes with each) -pig -cattle -fish -mosquito -snail -dog -cat -toxoplasma -none Has no intermediate host? -Threadworm/ roundworm What is interferon? -antivirus substance- inhibits protein synth of virus What virus is interferon used for? What is the disease produces by herpes simplex virus? -

What is the Rx for HIV? What is the Rx for AIDS? What is dane particle/ hepanda virus? -Hepatitis B virus Hepatitis B vaccine contains? what is Australian Ag? How do we get the infection?

-needle prick (most common)

What is the Rx? -Hepatitis C caused by? (most common in drug addicts) -needle prick (most common)

Hepatitis A causes by? What is hook worm? What is the mode of infection of hook worm? -through the larva penetrating through skin (walking barefoot) What is the manifestation of hook worm? -anemia What is blood fluke? What is symptom of blood fluke? What is cercariae? Which has two intermediate hosts? Black fly transmits what disease? Tse Tse fly? What is flucanazol? -antifungal What is flotrimoxizol? -antifungal

What is metanazol? Toxocara canis cause? -visceral larva migrams Host? -dog Mode of transmission? Rx? -eventually encapsulate and die -dog to be dewormed End host? -humans are dead end host

EXAM: 50% virology 50% parasitology NOT LAB DIAGNOSIS Name of infection Other name of disease Mode of infection Symptoms of infection Treatment Life cycle diagrams