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Clinical Medicine 1 > Influenza > Flashcards

Influenza Flashcards

1
Q

What type of transmission is this describing:
- person-to-person
- contaminated surfaces (hospital surfaces/equipment)
- requires contact precautions

A

contact transmission

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2
Q

What spreads by direct contact?

(bacteria, viruses, etc; possibly illnesses)

A
  • most bacteria and viruses
  • infectious diarrheas easily spread by contact
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3
Q

What type of transmission is this describing:
- how many URTI are transmitted
- size > 5 µm
- travels about 1-2 meters

A

droplet transmission

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4
Q

What type of respiratory infection is more commonly transmitted via droplets?

A

URTI > LRTI

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5
Q

If a droplet can travel beyond 2 meters, we call it transmission by (…)

A

aerosols

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6
Q

What type of transmission is this describing:
- size: 2-5 µm
- can suspend in air for minutes to hours or more
- important to follow precautions such as N95 or PAPR mask

A

airborne transmission

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7
Q

What type of transmission is this describing:
- inanimate object serves as agent involved in transmission between individuals
- both bacteria and viruses

A

fomite transmission

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8
Q
  • When was influenza isolated and identified?
  • It is likely that influenza has been causing outbreaks every (…) years over at least the last 400-500 years
  • About how many pandemic flu outbreaks have occurred over the last 500 years?
  • Some influenza outbreaks have been associated with what?
A
  • 1933
  • every 1-3 years
  • 14 pandemic flu outbreaks
  • high mortality rate, development of severe respiratory symptoms/pneumonia
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9
Q
  • What is the highest single fatal human event in history?
  • In some populations, the mortality rate of this is what?
  • Half of the deaths were in what age group?
  • What percentage of all young adults of the world may have died due to this?
  • This killed more people is how many weeks compared to AIDS in 25 years?
A
  • Pandemic Influenza 1918-1919
  • 25-40%
  • 20-40 y/o
  • 8-10%
  • 24 weeks
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10
Q
  • What is the annual estimate of influenza deaths reported by WHO?
  • What percentage of the population can be infected with influenza each season, but is typically higher in pandemic flu seasons?
  • Influenza outbreaks are worst when?
  • Influenza is best transmitted in what conditions?
A
  • 250,000-500,000 deaths anually
  • 10-20%
  • during the winter months
  • low temperatures (41 degrees F) and low humidity (20%)
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11
Q
  • What months in the northern hemisphere is influenza most active?
  • What months in the southern hemisphere is influenza most active?
A
  • November to March
  • May to September
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12
Q
  • When should a patient get the flu vaccine?
  • Why don’t you want a patient to get the vaccine too early?
A
  • late september/early october
  • waning immunity lasts about 6 months (so when flu is most active, won’t have immunity)
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13
Q

Which influenza is this describing:
- can cause severe/widespread pandemic disease
- affects humans, mammals, birds

A

influenza A

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14
Q

Which influenza is this describing:
- can cause severe disease; less likely to cause pandemics
- only affects humans

A

Influenza B

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15
Q

Which influenza is this describing:
- causes mild disease; does not cause pandemics
- does not follow seasonal patterns

A

influenza C

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16
Q
  • Influenza A is divided into subtypes based on what?
  • What is a glycoprotein responsible for binding the virus to epithelial cell at the sialic acid receptor and elicits antibody responses?
  • What promotes viral release from the host cell?
  • What is the most common subtypes found in humans?
A
  • hemagglutinin antigen and neuraminidase antigen
  • hemagglutinin antigen
  • neuraminidase antigen
  • H1→H3 and N1→N2
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17
Q

Strains of influenza A are identified by what?

(there are 4)

A
  1. type
  2. place of original isolation
  3. date of original isolation
  4. HA and NA antigen
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18
Q

What is this describing:
- occurs with antigen changes within the HA and NA genes
- results in some change in the virus, but does not typically lead to pandemics
- leads to variation between seasons
- can result in mismatch for selection of 4 vaccine strains chosen each year

A

Antigenic drift

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19
Q
  • In what influenza strains does antigenic drift occur?
  • In what influenza strains does antigenic shift occur?
A
  • both A and B
  • only A
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20
Q

What is this describing:
- reassortment of genes for novel NA or HA/NA combo from cross-species
- cause of major pandemics

A

antigenic shift

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21
Q

What first appeared in spring of 2009 and represented a triple assortment of avian, swine, and human influenza viruses that combined with a pig influenza virus?

A

2009 H1N1 pandemic flu

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22
Q
  • The 2009 pandemic flu virus was the same as the 1918 pandemic, but with different (…)
  • This represented a novel (…) virus
  • This pandemic slowly began to taper off by (…) and was declared over by WHO in (…)
  • What is the death toll estimate of this pandemic and from what?
A
  • genetic arrangments
  • influenza A
  • November 2009; August 2010
  • 200,000-400,000 from cardiovascular complications
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23
Q

Influenza B doesn’t undergo antigenic shift, so it is only named after what?

(3 things)

A
  1. type
  2. geography
  3. date of isolation
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24
Q

What are most influenza B lineages referred to as?

A
  • Victoria lineage
  • Yamagata lineage
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25
Q
  • What is the incubation period for the flu?
  • How is influenza spread?
A
  • 2-4 days
    transmission:
  • respiratory droplets (avoid coughers/sneezers, children are perilous, close contacts in winter)
  • fomites (survives on surfaces as long as 24-48 hours)
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26
Q

What handwashing method is best for flu prevention?

A

soap and water

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27
Q

What is the mechanism of infection of the flu virus?

A
  1. virus enters respiratory tract
  2. upon meeting respiratory epithelium, the hemagglutinin on envelope of virus attaches to sialic acid receptor on epithelial cell surface
  3. virus structure is internalized into cell in an acidic endosome
  4. further changes allow genetic material of virus to uncoat, leave the virus, and enter cytoplams and make its way to nucleus
  5. within the nucleus, viral RNA replication occurs and viral progeny are formed and released to cell surface
  6. Neuramidiase allows virus to “escape” cell and “not stick” to surface of host cell
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28
Q

The influenza virus:
- targets the cells of (…), disabling the body’s first line of defense
- attacks the epithelial cells of the (…) and (…), causing inflammation and edema
- travels to the lower respiratory tract and induces shedding of epithelium of the respiratory tract, (…) and (…)
- has the ability to promote and aid in (…) to epithelial cells, causing increased risk for (…)

A
  • mucociliary clearance system
  • trachea and bronchi
  • necrosis and apoptosis
  • bacterial adhesion; secondary bacterial pneumonia
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29
Q
  • The influenza virus has an amazing ability to do what?
  • Direct (…) of cells also occurs
  • Infection of the larynx, trachea, and bronchi result in (…), (…), and possibly eventual (…) of the cells
  • Tissue can (…), (…) and become (…)
A
  • shut off protein synthesis in host cells resulting in host cellular death; release as many influenza virion as possible
  • apoptosis
  • inflammation, edema, desquamation
  • hemorrhage, ulcerate, necrotic
30
Q

Describe the bodies mechanism of defense to the influenza virus

A
  • the body releases cytokines which cause the severe systemic symptoms associated with flu infection (fever, myalgias, fatigue)
  • IgG, IgM, and IgA are formed within one week of infection (against the HA, but can also form against NA)
  • CD8 + cytotoxic T cells and CD4 + helper T cells help resolve influenza infection
31
Q

What are some of the different cytokines released in an influenza infection?

A
  • interferon-alpha
  • interleukin-6
  • tumer necrosis factor
32
Q

What is the definition of a fever?

A

T > 100.4°F

33
Q

What are these manifestations associated with:
- toxic appearance
- fever (pronounced, shaking chills, intense and often unremitting, usually lasts 3-4 days by can be as long as 8 days)
- myalgias (back muscles frequently involved, extremities, thigh myalgias common in children)

A

influenza

34
Q

What are the hallmark signs of the flu?

A
  • toxic appearance
  • fever
  • myalgias
35
Q

Not all patients with the flu will have a (…), but most will. Absence of this may cause (…) as it is a hallmark sign due to its severity

A
  • fever
  • misdiagnosis/underdiagnosis
36
Q

If a patient expresses they can identify the hour/moment they felt the presence of an ailment (feeling of fatigue, fever, or achiness), what is the probably cause?

A

influenza

37
Q

What are the clinical manifestations of the flu that will be minor or mildly bothersome and may not even mention these when describing their illness?

A
  • malaise/fatigue
  • loss of appetite
  • headache
  • mild sore throat
  • non-productive cough
  • mild nasal congestion
38
Q

What are these clinical pearls associated with:
- patients presenting with symptoms during the “pumpkins to easter bunny” time frame
- hurting everywhere, may stat they feel like they were “hit by a truck” or that “their hair hurts”
- pinpointing the exact time of onset of infection
- cough and congestion not usually their primary complaints

A

influenza

39
Q
  • The influenza virus can be detected approximately how many days before onset of symptoms?
  • The virus is shed for how long?
  • The severity of symptoms usually corresponds with the release of what?
  • When is it okay to return to activities/work?
  • Who should you recommend patients stay away from if they have the flu?
A
  • 1 day
  • 5-10 days
  • cytokines
  • free of fever for at least 24 hours (or when symptoms subside)
  • elderly (over 65 y/o) or children under 5
40
Q

What are the differential diagnosis of influenza (infections that may present similarly)? Describe what makes these specific.

A
  1. pneumonia: specific abnormal lung sounds (crackles)
  2. covid-19: very similar to flu, anosmia distinct with delta strain
  3. upper respiratory virus: nasal congestion prominent, fever absent, minimal myalgias
  4. acute sinusitis: prominant pain over sinuses, thick nasal secretions, minimal myalgias
  5. acute bronchitis: cough is prominent feature, fever typically absent, abnormal lung sounds (wheeze)
  6. cytomegalovirus: fatigue and fever, but more chronic nature of symptoms, lacks rapid onset of flu
41
Q

What are the clinical manifestations of influenza in elderly patients?

A
  • high fever or no fever
  • confusion
  • fatigue
  • lassitude
    elderly pts may present with diminished symptomatology when compared to younger persons
42
Q

What should you look for when doing a physical examination on a patient who may have the flu?

A
  • vital signs (body temp, are they hypotensive, tachycardic, is there a pulse ox reading to see if they are dyspneuic)
  • general appearance (is the pt toxic)
  • perform HEENT exam (eyes may be watery, nasal discharge, lymph nodes may be slighly enlarged)
  • perform cardiovascular and lung exams (rhonchi or rales)
43
Q

What can be described as a snoring or rumbling sound caused by fluid in large airways?

A

rhonchi

44
Q

What can be described as crackling sounds caused by fluid in the alveoli?

A

rales

45
Q
  • Influenza diagnosis can be made on clinical manifestations alone and (…)
  • Some studies show that accuracy of using clinical manifestations is (…)%
  • Increasing accuracy with higher levels of (…) but is not as reliable an indicator to use in young children since they are prone to many illnesses that manifest with this
  • It is less accurate to use clinical manifestations to diagnose in the (…) as they may not manifest typically
A
  • seasonal epidemiology
  • 80-90%
  • fever
  • elderly
46
Q

What can you use to test for the flu? Describe this.

A

Rapid influenza tests:
- nasopharyngeal swab
- results in 15 minutes
- can differentiate between A and B
- allows rapid treatment with antiviral medication
- sensitivity variable depending on viral shedding amount

47
Q

When should you test for the flu and provide treatment (antiviral)?

A
  • within 48 hours of influenza illness onset
48
Q

Antiviral treatment is recommended for any patient with confirmed or suspected individuals who:

A
  • is hospitalized
  • has severe, complicated, or progressive illness
  • is at higher risk for influenza complications
49
Q

Which patients are at risk of influenza complications?

A
  • age younger than 2
  • age over 65
  • severe chronic medical conditions (pulmonary, cardiac, renal, hepatic, neurologic, metabolic conditions)
  • immunosuppressed pts
  • women w/in 2 weeks of postpartum delivery
  • age younger than 19 on long-term aspirin
  • american indians/alaska natives
  • obesity with a BMI over 40
  • residents of nursing homes or chronic care facilities
50
Q
  • What are some additional influenza tests you can order that may or may not be necessary?
  • What should you use to guide you in this decision?
A
  • CBC, CXR, rapid strep
  • history and physical examination
51
Q
  • Influenza can result in primary (…)
  • What can this lead to?
  • This is more common in patients with what?
  • What type of progression is this to cough, dyspnea, and hypoxemia?
  • Patient mortality rates are high due to what?
A
  • primary viral pneumonia
  • hypoxia, sepsis, and death
  • pts with underlying cardiac or respiratory disease
  • quick progression
  • antibiotics not helpings (virus not bacteria)
52
Q

What are the characteristics of primary viral influenza pneumonia?

A
  • bilateral involvement common with “patchy” areas of infiltrate
  • can rapidly progress to severe respiratory distress syndrome appearance
53
Q
  • Influenza complications also consist of a secondary (…)
  • This was the primary cause of death in what?
A
  • secondary bacterial pneumonia infection
  • 1918-1919 pandemic
54
Q

What are the causative organisms frequently identified in the secondary bacterial pneumonia infection as an influenza complication?

A
  • streptococcus pneumonia
  • staphylococcus aureus
  • haemophilus influenza
55
Q
A
56
Q

What are the characteristics of secondary bacterial influenza pneumonia?

A
  • lobar appearance
  • frequently, patient will improve after initial influenza prodrome and then become symptomatic again
    **re-evaluate if pt becomes febrile or sicker after initial defervescence
    **typically happens within a week of influenza onset
57
Q

What are some other less common complications of influenza?

A
  • croup
  • severe myalgias (can progress to severe rhabdomyolysis)
  • myocarditis and pericarditis
  • toxic shock syndrome
  • guillain-barre syndrome
  • Reye’s syndome
58
Q

What is this describing:
presents with harsh, barking cough and more common in pediatric population

A

croup

59
Q

What usually occurs from secondary staphylococcus aureus infections?

A

toxic shock syndrome

60
Q

What is this describing:
immune response that occurs against the peripheral nervous system and can cause symptoms from tingling in extremities to complete descending paralysis

A

guillain-barre syndrome

61
Q

What influenza complication can occur when recovering from the virus and may be recipitated by the use of aspiris so do not use aspirin for children as pain reliever or fever reducer or in any child with possible virus of any kind

A

reye’s syndrome

62
Q
  • Initiation of antiviral therapy works best when begun within the first (…) hours of symptom onset
  • After this time window, antivirals have very little (…) and should not be given to those in (…) of influenza
  • Antiviral medications can shorten the duration of symptoms by (…)
A
  • 48 hours
  • very little benefit; recovery phase
  • 1/2 to 3 days
63
Q

To treat or not to treat:
- scenario 1: pt presents withing 48 hours of smptom onset
- scenario 2: pt presents after 48 hours and has no underlying co-morbidities
- scanario 3: patient presents after 48 hours and has underlying co-morbidities
- scenario 4: patient is hospitalized with influenza complications or develops influenza while hospitalized
- scenario 5: patient was exposed to a case of influenza

A
  1. treat w/ antiviral
  2. not necessary to treat
  3. treat
  4. treat
  5. treat w/ prophylactic regimen
64
Q

What are the different antiviral medications that can be used for flu treatment?

A
  • zanamivir (relenza)
  • oseltamivir (tamiflu)
  • baloxivir (xofluza)
  • peramivir (rapivab)
65
Q

Which antiviral is this describing:
- neuraminidase inhibitor
- inhaler because medication has poor oral bioavailability
- effective A and B
- dose: 2 inh bid x 5 days, prophy: 2 inh once daily x 10 days over age 7

A

zanamivir

66
Q

Which antiviral is this describing:
- neuraminidase inhibitor
- capsule form or liquid
- effective A and B
- treatment dose: 75 mg bid x 5 days
- prophy dose: 75 mg once a day x 10 days

A

oseltamivir (tamiflu)

67
Q

Which antiviral is this describing:
- endonuclease inhibitor
- active against A and B
- single dose for treatment: comes in 20 mg and 40 mg tablets
- dosing is 40 mg if pt 40-80 kg and 80 mg is over 80 kg
- no prophy dose approved

A

baloxivir

68
Q

Which antiviral is this describing:
- neuraminidase inhibitor
- given parenterally (IV)
- given IV 600 mg as a single dose
- due to expense, used in the hospital setting and in critically ill pts

A

peramivir

69
Q

What is the preferred antiviral choice for pts with influenza in all settings according to the CDC?

A

oseltamivir

70
Q

In pts who cannot tolerate or absorb Oseltamivir due to GI concerns or side effects, which antiviral should be considered?

A

peramivir

71
Q

CDC states that there is not sufficient information to use zanamivir or paremivir in pts with what?

A

severe influenza disease

72
Q
  • (…) can be given to those who have been in close contact with an individual who has tested positive for the flu
  • This includes which individuals?
  • Decision to use prophylaxis should be made on a case-by-case basis, but pts at higher risk of (…) should be given priority
  • Dosing for prophylaxis by be different than for treatment, describe this.
A
  • antivirals
  • those who have had close contact with, lived with, or shared close
  • influenza-related complications
  • prophylaxic doses are half the dose for twice as long compared to the treament dose

Clinical Medicine 1 (4 decks)

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