Week 139 - Influenza

Question 1

What happens to arteries and vein as you age?

Answer 1

Stiffen

Question 2

What genetic material are Icosahedral viruses likely to have?

Answer 2

DNA & RNA

Question 3

What genetic material are Helical viruses likely to have?

Answer 3

RNA only (e.g. rabies, measles)

Question 4

What genetic material are “Complex” viruses likely to have?

Answer 4

RNA mostly (e.g. smallpox, influenza)

Question 5

Given an example of an Orthomyxoviridae virus

Answer 5

Influenza

Question 6

Given an example of a Paramyxoviridae virus

Answer 6

RSV, Parainfluenza, Measles, Mumps

Question 7

Given an example of a Picornaviridae virus

Answer 7

Polio, Rhinovirus

Question 8

What viruses can infect by surface fusion?

Answer 8

Enveloped only (ph dependent process)

Question 9

What can aciclovir be used to treat?

Answer 9

Similar to Guanosine

HSV and VZV only (due to viral thymine kinase)

Question 10

What can ganciclovir be used for?

Answer 10

CMV (retinitis, pneumonia)

Question 11

What are the side effects of ganciclovir?

Answer 11

Neutropenia, anaemia, thrombocytopenia

Question 12

What agents can be used for treatment of influenza?

Answer 12

Oseltamivir (Tamiflu) - within 48hrs
Zanamivir (Relenza) - within 36hrs
Neuraminidase inhibitors

Question 13

What is a capsid?

Answer 13

Protein coat covering the nucleoprotein core or nucleic acid

Question 14

What is a capsomere?

Answer 14

Protein clusters making up discrete subunits of a viral protein shell

Question 15

What are the common causes of delirium?

Answer 15

UTI
Drugs
General anasthetics

Question 16

What factors change with age that affect absorption of drugs?

Answer 16

↑Achlorhydria (ketoconazole, tetracyclins)

↓First Pass metabolism (β-blockers, Ca channel blockers)

Question 17

What factors change with age that affect distribution of drugs?

Answer 17

↑Body Fat (↑distribution of lipophilic drugs, ↓hydrophilic drugs)

Question 18

What is volume of distribution and what do the values mean?

Answer 18

↑Volume of distribution = drugs stays in blood

↓Volume of distribution = drugs goes to tissues

Question 19

What happens to renal drug metabolism with increasing age?

Answer 19

↓Renal function

Elderly may have “normal” creatinine with poor renal function (due to ↓muscle)

Question 20

What is Digoxin toxicity characterised by?

Answer 20

Dysrhythmias
Nausea and Vomiting
Xanthopsia (things look yellow)
Exacerbated by hypokalaemia
T wave inversion

Question 21

What is an enterovirus?

Answer 21

A genus of Picornaviridae that preferentially replicate in the mammalian intestinal tract

Question 22

What is a Herpetic whitlow?

Answer 22

A herpes viral infection that results in a painful blistery eruption on one of the digits

Question 23

What is antigenic drift?

Answer 23

RNA-dependent RNA polymerase - “no proof reading”
Causing “mistakes”
Immunity to previous influenza provides SOME protection

Question 24

What is antigenic shift?

Answer 24

Infection of same cell by two different Flu types, often from different species
Reassortment

Question 25

When is Oseltamivir & Zanamivir recommended?

Answer 25

1) Virus is circulating 2) Person is in "at-risk" group 3) Presentation with illness within 48hrs

Question 26

How does NICE define a person "at-risk" of Influenza Infection?

Answer 26

``` Chronic Respiratory Disease Chronic Heart Disease Chronic Renal Disease Chronic Liver Disease Chronic Neurological Conditions Diabetes Mellitus Immunosuppressed >65yrs ```

Question 27

Who is Influenza vaccine offered to?

Answer 27

All those >65yrs All those 6months-64yrs in "clinical risk group" All those 2-18yrs

Question 28

What is Type I or α error?

Answer 28

False Positive Result

Question 29

What is Type II or β error?

Answer 29

False Negative Result

Question 30

What are the types of RANDOM ERRORS?

Answer 30

Type I and Type II

Question 31

What are the sources of error in clinical trials?

Answer 31

Bias Random Error Confounding

Question 32

What is Bias and Confounding controlled by in a clinical trial?

Answer 32

Randomisation (for both) | And blinding for Bias

Question 33

How is Random Error controlled in a clinical trial?

Answer 33

Sample size and Significance level

Question 34

How can confounding be dealt with?

Answer 34

1) In the design of the study (matching, restriction) | 2) In the analysis (stratified analysis)

Question 35

What is Residual Confounding?

Answer 35

Occurs when all known confounders have been accounted for, but there are other unknown confounders

Question 36

What is the difference between cumulative incidence and incidence density?

Answer 36

Both incidences But Cum. Inc. deals with the "number" of people Whereas Incidence Density accounts for the number of "person-years"

Question 37

How is an Odd's ratio calculated?

Answer 37

Odds of getting something in a population odds diseased/odds healthy = Odds ratio or ad/bc= odds ratio

Question 38

How is a Relative Risk calculated?

Answer 38

RR= p.exposed/p.unexposed

Question 39

Why is Direct Standardisation method better than SMR?

Answer 39

SMR - quick, but does not account for stratification of data | D.S. - BUT need more accurate data