Influenza

Question 1

Type of influenza predominantly infecting humans

Answer 1

Influenza A and B

Question 2

Type of influenza responsible for pandemic outbreaks

Answer 2

influenza A

Question 3

Type of envelope protein responsible for entry of virus into cells and serves as viral attachment protein

Answer 3

Hemagglutin (HA) - surface antigen where antibodies are directed

Question 4

facilitate CELL-to-CELL spread of virus and the target for the antiviral drugs zanamivir and oseltamivir

Answer 4

Neuraminidase (NA)

Question 5

It is a structural protein integral to the INFECTIVITY of influenza and LINKING viral envelope with the core

Answer 5

Matrix proteins M1 and M2

Question 6

replacement of Introduction of new HA resulting into pandemic; influenza A

Answer 6

Antigenic shift

Question 7

mutations within the antibody-binding sites in HA, NA, or both; prevent antibodies against previous strains from being effective

Answer 7

ANTIGENIC DRIFT (both A and B)

Question 8

Incubation period

Answer 8

2-3 days (18 hours to 5 days or more)
can be as rapid as 18 hours
or as long as 5 or more days

Question 9

Young children shed ____ days or longer with generally higher viral titers.

Answer 9

10 days (vs adults 3-7 days)

Question 10

Influenza responsible for _____& of URTI in children.

Answer 10

5%–15%

Question 11

Individuals at high risk for influenza complication

Answer 11

Less than 2 yrs of age, Less than 19 yo on aspirin, >65 yo, morbidly obese BMI >40, all ages with comorbids

Question 12

apoptosis of the infected epithelial cells will lead to

Answer 12

acute tracheobronchitis

Question 13

Pathogenesis of influenza virus

Answer 13

attachment of viral HA to terminal sialic acids –> receptor-mediated endocytosis –> viral M2 forms ion channels -> Liberated viral RNA –> (mRNA) and viral RNA are synthesized –> budding of daughter virions –>NA facilitates virion release

Question 14

type I AECs are damaged leading to

Answer 14

acute alveolar damage –> ARDS
**tight junctions of the alveolar capillary membrane allow a transudate of fluid and proteins to enter the alveolar spaces

Question 15

Increased risk of secondary bacterial infection due to

Answer 15

delayed epithelial healing

Question 16

predisposes the host to allergic airway inflammation and asthma

Answer 16

TSLP stimulating dendritic cells to induce Th2 cells

Question 17

promoters of eosinophilic inflammation, excessive mucus secretion, and bronchial hyperresponsiveness

Answer 17

IL 25 and IL-33 (stimulates ILC2 to synthesize IL-5 and IL-13

Question 18

the best predictors of influenza infections

Answer 18

cough and fever

Question 19

young children presents with

Answer 19

o less classic presentation
o have higher fevers
o less prominent respiratory symptoms
o more GI symptoms such as abdominal pain, vomiting, diarrhea

Question 20

Rash is an uncommon but when it occurs it is usually

Answer 20

generalized maculopapular rash sparing the palms and soles.

Question 21

PE findings of influenza

Answer 21

• tachypnea
• conjunctival erythema
• nasal injection
• edema
• nasal discharge
• cervical adenopathy

Question 22

Most common radiographic finding

Answer 22

bilateral, symmetric, perihilar, and peribronchial opacities

Question 23

severe influenza

Answer 23

ARDS

Question 24

the most common pathogen identified in influenza

Answer 24

Strep pneumoniae

Question 25

Staphylococcus aureus

Answer 25

commonly associated copathogen

Question 26

o secondary fever after a period of defervescence
o focal findings on pulmonary auscultation
o lobar consolidation on chest imaging
o new onset of respiratory compromise occurring several days after initial symptoms

Answer 26

Bacterial superinfection

Question 27

False negative if tested

Answer 27

5 days beyond (decreased viral shedding)

Question 28

the most accurate testing modality for influenza
and useful for differentiating between influenza types and subtypes; MORE sensitive than rapid influenza antigen detection tests

Answer 28

RT PCR

Question 29

Early antiviral treatment (within 48 hours)

Answer 29

• can shorten the duration of fever, sx, hospitalizations
• reduce the risk of complications from influenza

Question 30

MOA of NI (oseltamivir and zanamivir)

Answer 30

inhibit the viral NA enzyme

Question 31

most common side effects of Oseltamivir

Answer 31

nausea and vomiting

Question 32

Serious adverse events of zanamavir

Answer 32

bronchospasm

Question 33

Children with anaphylaxis to eggs may receive influenza vaccine and observed for atleast

Answer 33

30 minutes

Question 34

Oseltamivir as prophylaxis

Answer 34

<1 yo

Question 35

Chemoprophylaxis to be effective

Answer 35

TAKEN EACH DAY for the duration of potential exposure to a person with influenza and CONTINUED for 7 days after the last known exposure

Question 36

o most common complication

Answer 36

otitis media

Question 37

o major complication

Answer 37

pneumonia