Respiratory Viruses (RSV, Influenza, Avian Flu, Adenovirus) Flashcards
RSV
Mid-October to Early January
<5 yr & >65 yr
5-day symptom onset
Wheezing / periods of apnea
Influenza
Fall or Winter
1-4 day symptom onset
1-7 day symptom duration
Avian Flu
HISTORY DEPENDENT
Exposure to dead poultry within
10 days of symptoms
EPIDEMIC IS CONCERN
Adenovirus
Year round
4-9 day symptom onset
A 2-year-old patient presents with low-grade fever, wheezing with periods of apnea, and increased mucous secretion. What is a likely diagnosis? A: seasonal influenza B: avian influenza C: Respiratory Syncytial Virus (RSV) D: pneumococcal pneumonia
C: Respiratory Syncytial Virus (RSV)
What age group is most at risk of contracting RSV?
Answer: <5 and older than 65 yr. old
What are the common outbreak times for RSV? A: January – Mid-March B: Mid-October – Early January C: November – February D: October – March
B: Mid-October – Early January
Answer: B (wintertime between mid-October until early January)
What is a common risk factor for RSV in children? A: age B: immunization status C: recent URI D: bottle fed
A: age
Answer: A (age; premature babies are at high risk of contracting RSV)
In addition to premature infants, who else is at risk for contracting RSV?
Answer: elderly, immunodeficiency, following lung/BM transplant
T or F: RSV is a leading cause of hospitalizations in young children
True
What is the average incubation period for RSV?
Answer: 5 days
What is a lab test that can detect RSV rapidly?
Answer: rapid nasal swab (viral antigen identification of nasal washings)
As an FNP, you know the treatment for RSV is?
Answer: supportive care (hydration, humidified air, ventilatory support – if needed)
T or F: RSV vaccine should be administered to children <2 years old and >65 yr old
Answer: False, there is no RSV vaccine
What are some preventative measures that can be taken to contain RSV / prevent further spreading of disease?
Answer: rapidly diagnose RSV, hand washing, contact isolation; administer pneumonia vaccine (to help decrease secondary viral infections
in kids)
How is influenza transmitted? A: droplet B: contact C: airborne D: standard precautions
A: droplet
Answer: A (respiratory route)
What two symptoms could a patient >4yr old present with during flu season, and you suspect the cause as flu?
Answer: presence of fever >38.2 and cough
In an unvaccinated adult, what symptoms would be seen when flu is suspected?
A: fever, chills, HA
B: altered mental status with respiratory symptoms
C: nausea, vomiting, abdominal pain
D: shortness of breath and BLE swelling
A: fever, chills, HA
In a child presenting with type B flu symptoms, what symptoms are expected? A: runny and stuffy nose, cough B: confusion without fever C: abdominal pain, vomiting, diarrhea D: wheezing and shortness of breath
Answer: C (children have GI complaints)
C: abdominal pain, vomiting, diarrhea
In the elderly presenting with flu-like symptoms, what symptoms are expected?
A: substernal soreness and chills
B: lassitude without respiratory symptoms
C: malaise, cough, and hoarseness
D: diarrhea and fever
Answer: B (confusion, lassitude, without respiratory symptoms)
What are the common outbreak times for Influenza?
Answer: fall or winter
Which type of influenza is exclusive to humans only?
Answer: Type B/C
What is the typical incubation period for influenza?
Answer: 1-4 days
Approximately how long should the patient diagnosed with influenza expect their fever to last?
Answer: 1-7 days (w/coryza, non-productive cough, sore throat)
What should the FNP suspect if a patient diagnosed with the flu has recurrent fever >4 days with productive cough and an elevated
WBC >10,000?
Answer: suspect secondary bacterial infection
What is the MOST common bacterial organism responsible for secondary bacterial infection in a patient with influenza?
Answer: pneumococcal pneumonia (staph pneumonia = the MOST serious)
What is the MOST appropriate lab to order to detect and diagnose influenza?
Answer: rapid flu swab
In determining whether a patient should be hospitalized with influenza, what is NOT a factor that should be considered? A: secondary pneumonia B: hypoxemia C: pregnancy D: persistent fever with cough
D: persistent fever with cough
Answer: D (fever can last 1-7 days; recurrent fever >4 days plus elevated WBCs would be grounds for admission; extrapulmonary
complications like pneumonia is grounds for admission (flu complicated by pneumonia you can almost bet they have hypoxemia)
What is a complication that can occur with kids diagnosed with Type B Influenza after having taken aspirin?
Answer: Reye syndrome
What is the standard of treatment for any patient with influenza?
Answer: supportive care
What factors should be considered and warrant administration of Zanamivir (Relenza) antiviral therapy? SELECT ALL THAT APPLY! A: acute illness B: onset of illness >48hr C: asthma D: pregnancy
A: acute illness
D: pregnancy
Answer: A & D (zanamivir is CONTRAINDICATED in asthma patients due to bronchospasm; therapy should be initiated within 48 hr of symptom onset)
What is the 1st line treatment for influenza if initiated within 48 hr. of symptom onset?
Answer: Tamiflu (75mg PO BID for 5 days)
AVIAN FLU
HISTORY DEPENDENT – Exposure to dead poultry within 10 days of symptoms – EPIDEMIC IS
CONCERN
A patient presents to your clinic with flu-like symptoms. What KEY distinguishing factor would direct the FNP to assume a diagnosis of avian flu? A: onset of symptoms began 48 hr. ago B: recent travel to Africa (last 6 days) C: hunting trip 9 days ago D: recent poultry consumption
C: hunting trip 9 days ago
Answer: C (hx of exposure to dead/ill birds or live poultry markers in prior 10 days, recent travel to Southeast Asia/Egypt, contact with
known case = HOW YOU DISTIGUISH FROM REGULAR INFLUENZA; there is NO RISK of contracting avian flu after consumption of
poultry products)
A patient presents to your clinic with Avian Flu. In addition to the symptoms of cough and fever, what symptom would indicate subtype H5N1 as the cause? A: purulent eye drainage B: mild gastroenteritis C: lymphadenopathy D: exudative tonsillitis
B: mild gastroenteritis
Answer: B (H5N1: aggressive course of illness; fever à lower resp. symptoms (cough/dyspnea) + GI) “5-piece mcNugget for 1 person”
A patient presents to your clinic with Avian Flu. In addition to the symptoms of cough and fever, what symptom would indicate subtype H7N9 as the cause?
A: shortness of breath and wheezing
B: red, diffuse rash on face
C: bilateral eye injection and drainage
D: decreased ability to handle secretions
C: bilateral eye injection and drainage
Answer: C (aggressive course of illness; fever à lower resp. symptoms (cough/dyspnea) + conjunctivitis) “9-7 = 2 Nasty eyes”
What is the MOST specific test to detect avian flu?
Answer: RT-PCR assays
What is REQUIRED from the FNP to do following a RT-PCR assay test?
Answer: must forward all results to public health authorities for further testing
T or F: With severe illness and confirmed cases of mild disease, treatment must be started within 48hr of diagnosis
Answer: False, treatment should begin IMMEDIATELY!
What is the 1st line drug for avian flu?
Answer: oseltamivir 75mg PO BID for 5 days (given immediately, but no later than 48hr of onset); patients need to be HOSPITALIZED and RECEIVE TREATMENT FOR 10 days
A recent outbreak of Avian Flu has been documented in your area. When discussing this information with your patients in clinic, a 56-yr. old male requested an appointment with your office to obtain a vaccine against this. What should you do?
Answer: Return the patients phone call to inform him that there is no specific vaccine against Avian Flu, however the patient could schedule
an appointment to receive the yearly flu vaccine as this will help prevent a coinfection of seasonal flu with avian flu
A patient exposed to avian flu presents to your office worried about what will happen. What is your next action? SELECT ALL THAT APPLY!
A: Prescribe oseltamivir 75mg PO BID for 5 days
B: Refer patient to ED for hospital admission due to need for droplet isolation
C: Perform a RT-PCR assay test
D: Instruct patient to monitor self for 10 days after known exposure
A: Prescribe oseltamivir 75mg PO BID for 5 days
D: Instruct patient to monitor self for 10 days after known exposure
Answer: A & D (further educate the patient to seek prompt medical attention if new fever or respiratory symptoms develop)
ADENOVIRUS INFECTIONS
Year round / 4-9 day symptom onset “AD”
Who are the most common individuals that contract adenovirus infections?
Answer: infants, young kids, and military recruits
What is the KEY determining factor that could distinguish between influenza and adenovirus?
Answer: adenovirus occurs throughout the year, versus influenza outbreak times are fall and winter
What is the typical incubation period for adenovirus infections?
Answer: 4-9 days (4=A, 9=D – adenovirus)
What are some illnesses caused by adenovirus? SELECT ALL THAT APPLY! A: gastritis B: common cold C: conjunctivitis D: pharyngitis E: acute otitis media
A: gastritis
B: common cold
C: conjunctivitis
D: pharyngitis
Answer: A, B, C, D (Also, pneumonia, acute respiratory distress, epidemic keratoconjunctivitis, acute hemorrhagic cystitis (kids), GU ulcers,
appendicitis, intussusception, hepatitis, rhabdomyolysis)
What main factors determine how severe adenovirus infections will be?
Answer: youth, chronic underlying conditions, recent transplant, and serotypes 5 and 21
What lab findings will determine the adenovirus serotypes?
Answer: antigen detection assays
What is the treatment regimen for adenovirus infections?
Answer: symptomatic, treat underlying cause; good hand hygiene
T or F: Along with hand washing and sterilizing equipment prevention measures, there is an adenovirus vaccine.
Answer: True, however – it is strictly for military use (not for general public)
