08.20 - Viral Pneumonia (Cross) - Questions

Question 1

Nearly all viruses that cause pneumonia can cause ___ as well

Answer 1

URTI’s

Question 2

Atypical Pneumonia (viruses) is an acute febrile respiratory disease characterized by

Answer 2

(1) Pathcy inflammatory changes; (2) Absence of consolidation; (3) Lack of alveolar exudates

Question 3

Path findings of Atypical Pneumonia

Answer 3

Alveolar walls infiltrated with mononuclear cells (Lymphocytes, Some plasma cells)

Question 4

Persistent cough and severe wheezing in 3 month old boy

Answer 4

RSV

Question 5

Features of RSV-1

Answer 5

Pleomorphic; Enveloped; Negative-sense; Single-stranded; Linear RNA

Question 6

Dx tests of RSV-1

Answer 6

RT-PCR on nasal swab or washings; Rapid antigen test on nasal swab or washings

Question 7

Which common group is not at risk for RSV pneumonia

Answer 7

45-year-old male with 20 pack-year smoking history

Question 8

In healthy adults, RSV presents as

Answer 8

common cold –> One way it may be transferred to infants

Question 9

Usual natural course of RSV in previously healthy infants

Answer 9

Bronchiolitis resolves w/out complications; Mortality rate low (2%)

Question 10

What patients can be severely affected by RSV

Answer 10

Premature; <12 weeks of age; Cardiopulmonary dz; Immunodeficiency

Question 11

Tx and Prevention Options for RSV

Answer 11

Palivizumab; Supportive care w/ hydration, albuterol, oxygen; Ribivirin not recommended

Question 12

Palivizumab

Answer 12

mAb against F protein - prevents binding of virus to host cell

Question 13

mAb against F protein - prevents binding of virus to host cell

Answer 13

Palivizumab

Question 14

Ribivirin in RSV

Answer 14

Routine use in children not recommended

Question 15

Why is RSV one of most likely viral infections to have a picture on step 1

Answer 15

Giant Cell (Syncitia) formation

Question 16

In whom is adenovirus most severe? Most commonly tested?

Answer 16

More severe in infants; Common in military

Question 17

Tx of Adenovirus

Answer 17

None

Question 18

Transmission of Adenovirus

Answer 18

Aerosol, Fecal-Oral, Direct inoculation

Question 19

Most common cause of respiratory tract infections that result in physician visits and hospitalizations in the US

Answer 19

Influenza

Question 20

Most common causes of post-viral secondary bacterial pneumonia

Answer 20

Strep Pneumo, then Staph Aureus

Question 21

2 important surface proteins found on influenza virus

Answer 21

Hemagluttinin; Neuraminidase

Question 22

Hemagluttinin

Answer 22

Attach influenza virus to its cellular target

Question 23

Attach influenza virus to its cellular target

Answer 23

Hemagluttinin

Question 24

Neuraminidase

Answer 24

Facilitates release of newly formed influenza virions

Question 25

Facilitates release of newly formed influenza virions

Answer 25

Neuraminidase

Question 26

Surface F Protein

Answer 26

Causes respiratory epithelial cells to fuse and form multinucleated giant cells (RSV)

Question 27

Causes respiratory epithelial cells to fuse and form multinucleated giant cells (RSV)

Answer 27

Surface F Protein

Question 28

Spike (S) Protein

Answer 28

Mediates fusion between Coronavirus and host cell membrane

Question 29

Mediates fusion between Coronavirus and host cell membrane

Answer 29

Spike (S) Protein

Question 30

How is influenza transmitted and what type of pathology occurs during infection?

Answer 30

Respiratory droplets; Necrosis of superficial layers of respiratory epithelium

Question 31

What results in emergence of new viral strains each year

Answer 31

Antigenic drift

Question 32

Antigenic drift results from

Answer 32

spontaneous mutations in viral genome as it replicates

Question 33

Antigenic shift results from

Answer 33

Reassortment of genome segments (encoding HA and NA genes in flu)

Question 34

Non-segmented negative strand RNA viruses: Shift or Drift

Answer 34

Drift, but not shift, because polymerase makes a lot of mistakes

Question 35

Confirmatory dx of influenza

Answer 35

RT-PCR of Nasopharyngeal Swab

Question 36

Rapid Urine Antigen Test is used in

Answer 36

Legionella, Strep Pneumo

Question 37

3 dx tests of influenza

Answer 37

RT-PCR; Direct fluorescent Ab; Rapid viral antigen test

Question 38

How should patient with influenza be treated

Answer 38

Oseltamavir, Zanamavir, Abx for secondary bacterial pneumonia

Question 39

Influenza important sequelae

Answer 39

Reye's Syndrome

Question 40

Adenovirus important sequelae

Answer 40

Bronchiectasis, Bronchiolitis Obliterans

Question 41

RSV improtant sequelae

Answer 41

Asthma

Question 42

Reye's Syndrome

Answer 42

Encephalopathy and Liver Degeneration; In children following viral infections

Question 43

What virus causes SARS

Answer 43

Coronavirus

Question 44

What virus causes MERS

Answer 44

Coronavirus

Question 45

Hantavirus multiplies in

Answer 45

Pulmonary capillary endothelial cells --> Bilateral pleural effusions w/ interstitial infiltrates of mononuclear cells

Question 46

Transmission of Hantavirus

Answer 46

Aerosol inhalation of rodent excreta (deer mouse)

Question 47

2 important points on HMPV

Answer 47

Respiratory droplets; Winter months

Question 48

Which virus is typically associated with croup and inspiratory stridor?

Answer 48

HPIV-1

Question 49

Typical presentation of Parainfluenza Viruses

Answer 49

Mild URTI, Croup, Bronchiolotitis and Pneumonia

Question 50

Prognosis of Parainfluenza virus

Answer 50

Good, most children recover after a few days. Reinfection common.