Influenza & RSV

Question 1

Define influenza

Answer 1

• highly contagious airborne disease

- acute febrile illness

Question 2

Describe influenza viruses

Answer 2

• encapsulated, single-stranded RNA

- family Orthomyxoviridae

Question 3

What are the most significant immunologic surface proteins of influenza?

Answer 3

• hemagglutinin (H)

- neuraminidase (N)

Question 4

What is the function of the influenza surface proteins?

Answer 4

• determine virulence

Question 5

What is the MOA of hemagglutinin?

Answer 5

• binds to respiratory cells allowing cellular infection

Question 6

What is the MOA of neuraminidase?

Answer 6

• cleaves the bond that holds newly replicated virions in the cell surface, permitting the spread of infection

Question 7

What allows for antigenic drift?

Answer 7

• poor error checking of viral RNA polymerase

Question 8

Define antigenic drift

Answer 8

• inaccurate viral RNA polymerase produces point mutations in error-prone gene regions

Question 9

Define antigenic shift

Answer 9

• genes resorted between 2 strains

Question 10

What is the presentation of influenza

Answer 10

• very abrupt
• fever/chills
• sore throat
• H/A
• ptosis
• myalgias
• URI type

Question 11

What are complications of influenza?

Answer 11

• PNA/2ndary bacterial PNA
• myositis
• myocarditis
• pericarditis

Question 12

What is the workup for influenza?

Answer 12

• viral culture
• rapid diagnostic test
• PCR
• serologic testing

Question 13

What is the tx for influenza?

Answer 13

• antiviral drugs
• isolation
• vaccines

Question 14

Define bronchiolitis

Answer 14

• lower airway (bronchioles) viral infection

Question 15

What is the etiology of bronchiolitis?

Answer 15

• MC: RSV

Question 16

What is the incubation period for bronchiolitis?

Answer 16

• 1-2d

- not uncommon s/p well child visit

Question 17

What are the S&S of bronchiolitis?

Answer 17

• fever
• rhinorrhea
• cough
• white frothy d/c

Question 18

What is seen on PE of bronchiolitis?

Answer 18

• wheezing

- tachypnea

Question 19

What diagnostics can be ordered for bronchiolitis?

Answer 19

• CXR (variable) will demonstrated hyperinflation

Question 20

T/F: Bronchiolitis is highly communicable.

Answer 20

• True ==> hand hygiene!

Question 21

What is the tx for bronchiolitits?

Answer 21

• observation
• supplemental O2
• parenteral fluids
• ? bronchodilators/steroids

Question 22

How is bronchiolitis prevented?

Answer 22

• hand hygine

Question 23

What is the leading cause of lower respiratory tract infections in infants and young children?

Answer 23

• RSV (respiratory syncytial virus)

Question 24

What are the S&S of RSV?

Answer 24

• low grade fever
• cough
• tachypnea
• cyanosis
• retractions
• wheezing
• apneic episodes
• not eating or sleeping
• profuse white, watery d/c

Question 25

What is a staccato cough associated with?

Answer 25

• Chlamydia trichoma

Question 26

What diagnostic tests can be done for RSV?

Answer 26

• CBC
• pulse ox
• culture/ antigen testing/PCR

Question 27

What is the tx of RSV?

Answer 27

• supportive care
• steroids
• bronchodilators
• alpha agonists
• racemic Epi
• ribavirin
• palivizumab

Question 28

Treating young children with pertussis with _____ has a risk of _______ _______.

Answer 28

• macrolides

- hypertrophic pyloric stenosis

Question 29

Cough w/o fever for couple weeks, now vomiting after early morning cough. Diagnose & tx me!

Answer 29

• pertussis

- macrolides

Question 30

14 y/o w/ disruptive, frequent daytime barking nonproductive cough, no fever cough is not heard at night. PE?

Answer 30

• probably nothing

- quiet expiratory phase

Question 31

Toddler awoke barking, struggling to catch her breath, mild fever, stridor & cough resolved on the drive to ER. CXR shows steeple sign. What am I and what is the tx?

Answer 31

• croup

- cool moist air, dexamethasone when very bad

Question 32

How do you treat Mycoplasma pneumonia?

Answer 32

• macrolides