Influenza

Question 1

influenza can cause acute ______ or viral ________

Answer 1

acute bronchitis
viral pneumonia

Question 2

disease that has spread over multiple countries or continents

Answer 2

pandemic

Question 3

disease that affects large amt of people within specific community, pop, or region

Answer 3

epidemic

Question 4

disease that occurs infreq/ irregularly with no discernible temporal or spatial pattern

Answer 4

sporadic

Question 5

a disease likely to be transmitted to people, organisms, etc (does not infer person to person (contagious))

Answer 5

infectious

Question 6

if a disease is contagious that means

Answer 6

it can be passed prson to person

Question 7

if a disease is infectious but not contagious that means

Answer 7

it can be passed to animal to animal to human, but not necessarily human to human

Question 8

Influenza is an ______virus that causes respiratory infection in humans

Answer 8

RNA

Question 9

Only influenza ___ can also infect pigs, birds (duck, geese, chickens) as well as cats, bats, and dogs among other animals

Answer 9

A

Question 10

substypes of influenza occur due to

Answer 10

polymorphisms in HA and NA surface proteins

Question 11

what is the vaccine target for influenza

Answer 11

hemagglutinin

Question 12

which type of influenza virus circulates in animals as well = primes for dramatic genetic recombination and has pandemic potential

Answer 12

A

Question 13

what type of influenza virus has the victoria and yamagata lineage

Answer 13

B

Question 14

which influenza virus affects cattle only

Answer 14

D

Question 15

type C influenza virus results in

Answer 15

possible mild illness, not threatening

Question 16

nondramatic mutations of HA/NA proteins as a consequence of reduced proofreading activity of RNA polymerase

Answer 16

antigenic drift

Question 17

antignic drift affects
1. type A
2. type B
3. both type A and B
4. neither

Answer 17

3

Question 18

antigenic shift affects
1. type A
2. type B
3. both type A and B
4. neither

Answer 18

1

Question 19

why is it important to get a new flu vaccine each year
1. missing it for one year will leave you susceptible to the new virus
2. we want to keep up to date on the mutants to avoid giving it to others
3. we want to build an immune library against severe illnesses in the future
4. none of the above

Answer 19

3

Question 20

what is influenza’s route of transmission

Answer 20

respiratory droplet
some fomite spread

Question 21

Influenza virus inhaled via respiratory droplets and binds to cells in upper airway respiratory__________ via ___________ to _________________

Answer 21

epithelium
haemagglutinin (HA)
sialic acid glycoprotein (SA)

Question 22

T or F: sometimes influenzas will colonize the LRT

Answer 22

T

Question 23

which of the following is true
1. influenza uses its own RNA polymerase to create mRNA
2. active viral infection is typically the culprit for mortality and morbidity
3. influenza binds via HA to SA
4. all of the above
5. 1+3

Answer 23

5

Question 24

active viral infections leaves patients prone to

Answer 24

secondary infections- bacterial or fungal

Question 25

patients are mostly contagious during

Answer 25

symptomatic phase

Question 26

symptomatic period begins ___, worst at ____ into illness, then recovers over ____ period

Answer 26

begins day 2 worst 2-3 days into illness recovers over 7-10 days

Question 27

what is the most evident sign that it is a viral infection

Answer 27

sick contacts

Question 28

a pt presents with sickness after a party last night. His friends are also sick. sx include SOB, nausea, vomiting, fever. This is most likely 1. viral 2. bacterial

Answer 28

2- simultaneously sick

Question 29

what is the common clinical presentation of lower airway disease

Answer 29

cough- commonly nonproductive but can be productive

Question 30

bloodwork in influenza sees

Answer 30

mild leukocytosis if any elevated acute phase reactants

Question 31

what is usually seen in diagnostic imaging for influenza

Answer 31

bilateral patchy opacities/ interstitial pattern

Question 32

list 3 features indicative of bacterial infection

Answer 32

No sick contacts Double sickening +/- Rapid acute onset (1-2 days ago) Severe illness (relative, not a rule) +/- purulent sputum V high leukocytosis (>15) Lobar infiltrate on CXR

Question 33

list 3 features indicativ of viral infection

Answer 33

Sick contacts Less severe or delayed onset >2-3 days +/- clear sputum or nonproductive Minor leukocytosis

Question 34

predominant URTI sx like rhinorrhea, sneezing, congestion, sore throat is more likely 1. COVID 2. influenza 3. common cold

Answer 34

3

Question 35

list 3 respiratory complications from influenza

Answer 35

ARDS secondary bacteria pneumo secondary fungal pneumo

Question 36

CNS complications of influenza

Answer 36

Febrile seizures (pediatric) Reye syndrome RARE others (encephalitis) GBS

Question 37

cardiac complications of influenza

Answer 37

Exacerbation of chronic HF Viral myocarditis/ pericarditis

Question 38

pregnancy complications in influenza

Answer 38

↑ obstetric/ maternal complications, ↑ infant prenatal fatality, ↑ risk of prematurity, lower BW

Question 39

the most common cause of death from influenza = ___ and _____

Answer 39

ARDS secondary bacterial pneumo

Question 40

what is the pathology of ARDS

Answer 40

exaggerated, dramatic, inappropriate immune response to pulmonary insult (Ex- viral infection, bacterial, trauma, foreign body aspiration, others) that leads to inability of the lung to participate in gas exchange

Question 41

T or F: we must push air in to ventilate pts with ARDs

Answer 41

F- pushing air doesn't work

Question 42

3 attempted tx for ARDS

Answer 42

MV + pharmacologic lung paralysis proning ECMO/ECLS

Question 43

what is ECMO

Answer 43

dialysis for the lungs performs gas exchange, Requires major CVICU procedure + is life threatening

Question 44

which of the following is false about ARDS 1. mortality rate is 80% 2. survivors commonly have CLD 3. pts of all ages can get ARDs 4. proning eventually fails

Answer 44

1- 50%

Question 45

list 3 times to refer for influenza

Answer 45

suspect evolution to bacterial illness ARDs difficulty breathing All pts <2yrs old with influenza Signs of hypoxia (cyanosis, altered lvl of consciousness, difficult to rouse) Seizure activity Double sickening (indicative of bacterial infection) Viral illness followed by apparent improvement, then sudden clinical worsening (double sickening)

Question 46

2 ways to diagnose influenza

Answer 46

rapid antigen testing molecular testing

Question 47

what is the main con of RAT testing for influenza

Answer 47

less sensitive, if negative doesn't rule it out

Question 48

what is the major con for molecular testing for influenza

Answer 48

most costly + long turn around time (24-72hrs)

Question 49

which 2 antivirals for influenza are marketed in canada

Answer 49

oseltamivir zanamivir

Question 50

oseltamivir and zanamivir are both (list 3 things)

Answer 50

neuraminidase inhibitors schedule 1 BID v well tolerated likely safe i npregnancy

Question 51

in pts requiring hospitalization 1. NAIs decreased mortality in children more than adults 2. NAIs increased the likelihood of death/ ICU if started before admission 3. NAIs decreased severe outcomes if started before admission 4. none of the above

Answer 51

3

Question 52

in pts not requiring hospitalization, NAIs... 1. more effect is seen when given after 24hrs 2. more effect is seen when given within 12-24hrs of illnses 3. sees conflicting data on development of ARDs 4. reduces rate of ARDs

Answer 52

2

Question 53

T or F: Oseltamivir prophylaxis, when given to high risk individuals, prevents development of symptomatic influenza (80% eff) when exposed to close contacts

Answer 53

T

Question 54

____________ is an oral capsule med that has an indication for pts (>12yrs) at high risk of serious or complicated influenza infxns if given within 48hrs (similar to NAIs)

Answer 54

baloxavir marboxil

Question 55

baloxavir marboxil should be given within _____

Answer 55

48hrs

Question 56

baloxavir marboxil is ____ tolerated, ______ dose(s), and of _____ efficacy compared to oseltamivir

Answer 56

well tolerated 1 dose similar eff to oseltamivir

Question 57

antiviral drug resistance is 1. possible + better characterized with other viruses like HIV 2. not a clinical concern 3. may become a clinical concern in the future as the virus mutates 4. 1+3

Answer 57

2

Question 58

what is the main issue with recognizing influenza

Answer 58

most pts present delayed to medical care- typically >48hrs since onset of illness

Question 59

T or F: you may decide to tx with antivirals before testing results are back

Answer 59

T- if local outbreak and pt presents with high risk = can just start it as delayed recognition may reduce benefit

Question 60

should you treat with NAI if influenza is caught <48hrs from onset, pt is immunocompetent

Answer 60

no

Question 61

should you treat with NAI if influenza <48hrs and pt is immunocomp and has risk for severe disease

Answer 61

yes

Question 62

should you treat with NAI if influenza caught after 48hrs and pt is hospitalized

Answer 62

yes

Question 63

should you treat with NAI if influenza caught after 48hrs and pt has been circulating in close quarters

Answer 63

yes

Question 64

should you treat with NAI if it's been >48hrs of influenza and the pt is otherwise healthy, not hospitalized, and no severe illness?

Answer 64

no

Question 65

list 3 nonpharm approaches to managing influenza

Answer 65

Rest and relaxation- avoid strenuous activity which could exacerbate respiratory illness if progressive pneumonia Cold compresses on forehead for fever Maintenance of fluid and food intake (esp elderly, reduced PO intake = develop AKI or electrolyte disturbances which would require admission)

Question 66

list 2 pharm measures for comfort in influenza

Answer 66

APAP/ ibuprofen reasonable for fever and muscle aches OTC antinauseants for N/V