Mehlman Influenza, COVID, vaccine table pulmo 03-11 (2) Flashcards
Influenza. CP 3 main?
Causes respiratory distress, fever, and myalgias (muscle pain)
Influenza. What HY CP?
For USMLE purposes, the myalgias are exceedingly HY as a vignette finding that usually suggests the flu over other diagnoses.
Influenza. virus has what structure?
Has 8 segments, two of which are hemagglutinin and neuraminidase.
Influenza. what does hemagglutinin?
Hemagglutinin mediates viral attachment to the cell by enabling its binding at sialic acid receptors
Influenza.
If a question asks about the molecule most flu vaccines are targeted against, the answer is ?
hemagglutinin
Influenza. Neuraminidase function?
Neuraminidase allows for newly synthesized viral particles to leave the host cell. This enzyme cleaves sialic acid residues, which normally bind the new viral particles within the cell. Once these residues are cleaved, the viral
particles can leave the cell.
Influenza. Drugs such as oseltamivir and zanamivir mechnism?
sialic acid analogues that function as neuraminidase competitive inhibitors.
In other words, they
prevent the virus from leaving the cell. If the USMLE asks which drug prevents viral spread within a community, or they tell you a drug is given and now host
cells are “packed with virions” (because they can’t leave the cell), the answer is one of the -mivirs.
Influenza. what is antigenic drift?
Antigenic drift is point mutations in hemagglutinin and/or neuraminidase, where the virus has changed slightly. It leads to seasonal epidemics.
Influenza. what is antigenic shift?
Antigenic shift is due to two influenza viruses entering a cell, one of human origin, the other of animal origin (such as bird or swine), where they engage in reassortment of viral segments, leading to a completely novel influenza virus. It leads to generational pandemics
Influenza. Patient gets a bacterial lobar pneumonia following recent convalescence
from influenza infection, mos?
S. aureus yra HY.
neduos s. aureus ir s. pneumo kartu tarp pasirinkimo variantu.
Influenza.
They’ll say something about how a guy recently recovered from a viral illness in which he had high fever and myalgias, and now he has a pneumonia caused by a gram-positive coccus in clusters –>
answer = S. aureus.
In contrast, S. pneumo is gram-positive diplococci.
.
Influenza.
IM killed vaccine. When?
Start age 6 months, then give yearly in the fall or winter throughout life; safe to give during pregnancy.
Influenza.
IM killed vaccine.
Pregnancy?
safe to give during pregnancy.
Influenza.
Intranasal live attenuated vaccine. age. in what population?
ages 2-45; immunocompetent, nonpregnant persons only
Influenza.
Intranasal live attenuated vaccine. pregnancy?
nonpregnant persons only
COVID.
Has characteristic spike proteins that create a crown-like appearance on electron microscopy.
The spike proteins bind to ACE2 receptor, allowing for viral fusion with host respiratory epithelium.
.
COVID. CP?
Presentation can range from mild respiratory symptoms similar to the
common cold (rhinovirus) all the way to severe respiratory disease with multiorgan failure.
COVID.
Many different vaccine types exist - i.e., mRNA (Moderna; delivers mRNA coding for the spike protein),
viral vector (AstraZeneca; delivers mRNA in a harmless viral capsid),
and killed (Sinovac; delivers inactivated, killed virus)
.
COVID. vaccines adverse?
Both live viral infection as well as vaccination are known to cause rare
adverse effects, such as Bell’s palsy and myocarditis, although these effects are not unique to coronavirus and can rarely happen with many viral infections and vaccines.
COVID. vaccine for kids?
Vaccination schedule for children now recommends IM vaccine starting at 6 months; 2-3-doses.
Vaccine table.
S. pneumo.
PCV15, age? 4
at 2, 4, 6 months, then again 12-15 months
Vaccine table.
at 2, 4, 6 months, then again 12-15 months.
what vaccine?
S. pneumo.
PCV15
Vaccine table.
Age >=65.
What s. pneumo vaccine if once?
PCV20 once
Vaccine table.
Age >=65.
What s. pneumo vaccine if two?
PCV15 then PPSV23 a year later.
Vaccine table.
For asplenia/surgical splenectomy, sickle cell, cochlear implant, CSF leak, chronic renal failure/nephrotic syndrome, HIV, and immunosuppressed
patients:
Vaccination?
extra dose of PCV15, followed by PPSV23 8+ weeks later.
Vaccine table.
Influenza.
IM killed vaccine age? pregnancy?
IM killed vaccine: start age 6 months, then give yearly through life; safe
to give during pregnancy.
Vaccine table.
Influenza.
Intranasal live-attenuated. age, pregnancy?
ages 2-45; immunocompetent, non-pregnant persons.
Vaccine table.
Influenza.
coronavirus. age, doses?
IM vaccine starting at 6 months; 2-3-doses.
