Influenza Overview and Pathophysiology
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What is the primary difference between antigenic drift and antigenic shift in influenza viruses?

  • Drift involves major changes, while shift involves minor changes.
  • Shift results from seasonal changes in climate, while drift follows genetic stability.
  • Drift leads to seasonal epidemics, while shift can cause pandemics. (correct)
  • Shift is due to point mutations, while drift is due to genetic reassortment.

    • Which pharmacologic agent is currently not recommended due to high resistance in influenza treatment?

  • Rimantadine (correct)
  • Baloxavir Marboxil
  • Zanamivir
  • Oseltamivir

    • What mechanism does SARS-CoV-2 use to enter host cells?

  • Exocytosis
  • Direct penetration
  • Fusion with the cell membrane
  • Endocytosis (correct)

    • Which of the following is NOT a common laboratory abnormality in hospitalized COVID-19 patients?

    <p>Low liver enzymes</p> Signup and view all the answers

    What type of COVID-19 vaccine is NOT classified as an mRNA vaccine?

    <p>Ad26.COV25 (J&amp;J/Janssen)</p> Signup and view all the answers

    What symptom is NOT typically associated with the clinical presentation of COVID-19?

    <p>Difficulty with balance</p> Signup and view all the answers

    Which risk factor is strongly associated with severe COVID-19 outcomes?

    <p>Age over 60 years</p> Signup and view all the answers

    Which of the following treatments is recommended for the management of long COVID?

    <p>Long-term monitoring and physical rehabilitation</p> Signup and view all the answers

    Which statement regarding the pathophysiology of SARS-CoV-2 infection is correct?

    <p>Viral RNA releases and uses cellular machinery for replication.</p> Signup and view all the answers

    What is a key component in the prevention of COVID-19 transmission?

    <p>Vaccination of high-risk populations</p> Signup and view all the answers

    In the late stage of COVID-19, what respiratory complication can occur?

    <p>Increased vascular permeability and edema</p> Signup and view all the answers

    What is a common adverse drug reaction of Tamiflu?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is the maximum recommended dose for Baloxavir Marboxil?

    <p>40mg once if weighing over 80kg</p> Signup and view all the answers

    What risk factor is associated with the likelihood of long COVID?

    <p>Older age and female gender</p> Signup and view all the answers

    Which influenza virus subtype is most commonly associated with requiring hospitalization?

    <p>Influenza A</p> Signup and view all the answers

    What is the primary mode of transmission for influenza?

    <p>Inhalation of respiratory droplets</p> Signup and view all the answers

    Which symptom is NOT commonly associated with influenza?

    <p>Rash</p> Signup and view all the answers

    Which type of influenza vaccine is a live attenuated vaccine?

    <p>LAIV</p> Signup and view all the answers

    What role does neuraminidase play in the pathophysiology of influenza?

    <p>Facilitates the release of new virions</p> Signup and view all the answers

    How long before the onset of influenza symptoms are adults contagious?

    <p>1 day</p> Signup and view all the answers

    Which of the following types of influenza virus is considered less pathogenic?

    <p>Influenza B</p> Signup and view all the answers

    Which of the following statements about influenza transmission is true?

    <p>Viral shedding can occur for weeks in severely immunocompromised individuals.</p> Signup and view all the answers

    What should patients be counseled to refrain from doing for 7 days after treatment?

    <p>Sexual activity</p> Signup and view all the answers

    Which symptom is not commonly associated with genital warts?

    <p>Cough</p> Signup and view all the answers

    Which of the following is a method for diagnosing bacterial vaginitis?

    <p>Vaginal gram stain</p> Signup and view all the answers

    What is a notable side effect of metronidazole?

    <p>Metallic taste</p> Signup and view all the answers

    Which method is used consistently for treating genital warts?

    <p>Cryotherapy with liquid nitrogen</p> Signup and view all the answers

    What is indicated by the presence of black dots within the warts?

    <p>Vascular involvement</p> Signup and view all the answers

    What is the recommended treatment for bacterial vaginitis?

    <p>Metronidazole oral 500mg BID for 7 days</p> Signup and view all the answers

    Which of the following patients should undergo cervical cancer testing?

    <p>Patients diagnosed with HPV</p> Signup and view all the answers

    Which diagnostic test is indicative of bacterial vaginitis when clue cells are observed?

    <p>Vaginal gram stain</p> Signup and view all the answers

    What is a common symptom associated with genital warts?

    <p>Anogenital pruritus</p> Signup and view all the answers

    Which of the following statements about the HPV vaccine is correct?

    <p>It is available for individuals aged 9-26 years.</p> Signup and view all the answers

    What is the vaginal pH level that indicates bacterial vaginitis?

    <p>Greater than 4.5</p> Signup and view all the answers

    Which treatment method is recommended for bacterial vaginitis?

    <p>Metronidazole 500mg BID for 7 days</p> Signup and view all the answers

    What is the characteristic feature seen in warts caused by HPV?

    <p>Rough, thick, cauliflower-like lesions</p> Signup and view all the answers

    What is a common side effect of metronidazole?

    <p>Metallic taste</p> Signup and view all the answers

    Which symptom is typically associated with Jarisch-Herxheimer reaction (JHR)?

    <p>Hypotension</p> Signup and view all the answers

    What distinguishes Jarisch-Herxheimer reaction from an allergic reaction to penicillin?

    <p>JHR resolves spontaneously while treatment continues.</p> Signup and view all the answers

    Which of the following conditions would contraindicate the use of the live attenuated influenza vaccine (LAIV)?

    <p>Pregnancy</p> Signup and view all the answers

    For which antimicrobial medication is the risk of resistance higher in immunocompromised patients with influenza?

    <p>Amantadine</p> Signup and view all the answers

    What is a common side effect of Penicillin G Benzathine?

    <p>Diarrhea</p> Signup and view all the answers

    Which symptom is NOT typically related to the live attenuated influenza vaccine?

    <p>Anaphylaxis</p> Signup and view all the answers

    What type of patient is most likely to experience Jarisch-Herxheimer reaction?

    <p>Patients receiving treatment for syphilis</p> Signup and view all the answers

    Which of these symptoms would be least expected in a patient with influenza after receiving the appropriate antiviral treatment?

    <p>Skin irritation</p> Signup and view all the answers

    What is the main reason why Influenza A is considered the most significant among influenza viruses?

    <p>It has a high potential for causing pandemics.</p> Signup and view all the answers

    Which mechanism is primarily responsible for the spread of the influenza virus once it enters the respiratory epithelial cells?

    <p>Neuraminidase aids in the release of viral particles.</p> Signup and view all the answers

    What symptom is not typically associated with influenza during the acute phase of the illness?

    <p>Confusion</p> Signup and view all the answers

    How long is the typical incubation period for influenza before symptoms appear?

    <p>1-7 days</p> Signup and view all the answers

    Which type of influenza vaccine is classified as live attenuated?

    <p>LAIV</p> Signup and view all the answers

    What is a common misconception about Influenza B compared to Influenza A?

    <p>It is divided into subtypes.</p> Signup and view all the answers

    What role does hemagglutinin play in the pathophysiology of influenza infection?

    <p>It binds to respiratory epithelial cells.</p> Signup and view all the answers

    Which statement regarding the timing of infectiousness in adults with influenza is accurate?

    <p>Adults can shed the virus 1 day before and up to 7 days after symptoms start.</p> Signup and view all the answers

    What is the appropriate treatment for a patient with primary syphilis?

    <p>Benzathine penicillin G IM single dose</p> Signup and view all the answers

    What is the first-line therapy for confirmed HSV-2?

    <p>Acyclovir</p> Signup and view all the answers

    Which treatment is appropriate for a patient diagnosed with trichomoniasis?

    <p>Metronidazole</p> Signup and view all the answers

    What is the recommended treatment for a patient diagnosed with bacterial vaginosis indicated by clue cells?

    <p>Metronidazole oral 500 mg BID x7 days</p> Signup and view all the answers

    Which test is considered the gold standard for diagnosing syphilis?

    <p>Treponemal test (FTA-ABS)</p> Signup and view all the answers

    Which factor notably increases the risk for severe COVID-19 complications in a patient with a BMI of 35 and recently diagnosed type 2 diabetes?

    <p>Recent diagnosis of diabetes</p> Signup and view all the answers

    What is the primary treatment goal for a patient diagnosed with mild COVID-19?

    <p>Manage symptoms and monitor for progression</p> Signup and view all the answers

    What is the first-line treatment for confirmed chlamydia in a patient presenting with dysuria?

    <p>Doxycycline 100 mg BID x7 days</p> Signup and view all the answers

    What condition is being managed with rescreening planned in 3 months due to high reinfection risk and "strawberry cervix"?

    <p>Trichomoniasis</p> Signup and view all the answers

    When counseling a patient about long-term side effects of the mRNA COVID-19 vaccine, which statement is appropriate?

    <p>Clinical studies show no evidence of severe long-term side effects.</p> Signup and view all the answers

    Which treatment is not typically used for syphilis?

    <p>Acyclovir</p> Signup and view all the answers

    What outpatient treatment is recommended for a 70-year-old patient with chronic kidney disease presenting with COVID-19 symptoms?

    <p>Paxlovid</p> Signup and view all the answers

    In the U.S., which prophylactic treatment for COVID-19 is no longer recommended?

    <p>Evusheld</p> Signup and view all the answers

    For a patient with a positive HLA-B*5701 test starting antiretroviral therapy (ART) for HIV, which medication should be avoided?

    <p>Abacavir</p> Signup and view all the answers

    What lab test would confirm an HIV diagnosis in a patient presenting with fever and lymphadenopathy after unprotected sex?

    <p>HIV antigen/antibody test</p> Signup and view all the answers

    Which of the following statements about COVID-19 vaccinations is correct regarding their composition?

    <p>Vaccines utilize mRNA to elicit an immune response.</p> Signup and view all the answers

    What is indicated by the numerals following the letter abbreviation for influenza vaccines?

    <p>The number of strains included in the vaccine</p> Signup and view all the answers

    Which pharmacologic agent is administered orally for the treatment of influenza A?

    <p>Baloxavir Marboxil</p> Signup and view all the answers

    What change in the influenza virus occurs due to antigenic drift?

    <p>Continual small mutations over time</p> Signup and view all the answers

    Which symptom is not typically associated with the early stage of COVID-19?

    <p>Hallucination</p> Signup and view all the answers

    What is the primary route of transmission for COVID-19?

    <p>Respiratory droplets during face-to-face contact</p> Signup and view all the answers

    Which of the following laboratory abnormalities is commonly observed in hospitalized COVID-19 patients?

    <p>Lymphopenia</p> Signup and view all the answers

    Which vaccination strategy is essential in managing long COVID?

    <p>Increased health finance</p> Signup and view all the answers

    What is a common adverse effect of Tamiflu?

    <p>Nausea and vomiting</p> Signup and view all the answers

    In severe COVID-19 cases, what is indicated by oxygen saturation levels less than or equal to 94%?

    <p>Requirement for oxygenation or ventilatory support</p> Signup and view all the answers

    Which treatment is recommended for bacterial vaginitis in women?

    <p>Metronidazole 500mg BID x7</p> Signup and view all the answers

    What is a risk factor for developing severe COVID-19 outcomes?

    <p>Underlying chronic diseases</p> Signup and view all the answers

    What is the effect of antigenic shift on influenza viruses?

    <p>Leads to major changes in hemagglutinin and/or neuraminidase</p> Signup and view all the answers

    What characterizes mild COVID-19 severity?

    <p>No need for hospitalization</p> Signup and view all the answers

    Study Notes

    Influenza

    • Highly contagious viral illness spread through respiratory droplets
    • Seasonal epidemics cause 25-50 million cases, ~200,000 hospitalizations, and >30,000 deaths per year in the US
    • Responsible for major pandemics

    Influenza A

    • Divided into subtypes based on two surface proteins: Hemagglutinin (H) and Neuraminidase (N)
    • H subtypes range from H1 to H16, with H3 and H1 being most common
    • N subtypes range from N1 to N9
    • A subtype is the biggest issue and cases of this subtype may require hospitalization

    Influenza B

    • Not divided into subtypes
    • Less pathogenic than type A
    • Usually does not require hospitalization

    Influenza C

    • Not divided into subtypes
    • Uncommon; generally mild

    Pathophysiology

    • Hemagglutinin binds to respiratory epithelial cells, allowing viral entry
    • Neuraminidase cleaves the bond holding replicating virions, allowing virus spread
    • Binding to sialic acid leads to entering the cell , triggering replication and release from the cell .

    Transmission

    • Infection occurs through contact with respiratory secretions or contaminated surfaces
    • Incubation period: 1-7 days (average 2 days)
    • Infectious period: 1 day before to 7 days after illness onset in adults; children may be infectious longer than 10 days.

    Long COVID

    • Pathogens: persistent viruses, autoimmune dysregulation, dysbiosis
    • Treatment: long-term monitoring, mental health care, social support, and physical rehabilitation
    • Risk factors for Long COVID: SAR-COV2 variants, severity of comorbidities, no vaccination, female, older, healthcare worker

    Clinical Presentation of Influenza

    • Fever, dry cough, SOB, fatigue, myalgia, nausea, vomiting
    • Headache, diarrhea, rhinorrhea, and anosmia (loss of smell) commonly occur

    Common Lab Abnormalities in Hospitalized Influenza Patients

    • Lymphopenia
    • Elevated inflammatory markers
    • Elevated sedimentation rate, C-reactive protein, ferritin, and tumour necrosis factor a
    • Abnormal coagulation parameters
    • Prolonged PT time, thrombocytopenia, low fibrinogen

    Prevention

    • Use of mRNA vaccines (e.g., BNT162b2, mRNA1273, Ad26.COV2)
    • Monoclonal antibodies (e.g., Evusheld) are used in cases of high risk
    • Pre-exposure prophylaxis (PREP) and post-exposure prophylaxis (PEP) are available for prevention of COVID-19.

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    Description

    Explore the key aspects of influenza, including its classification into types A, B, and C, as well as the viral mechanisms behind its transmission and pathology. Understand the impact of seasonal epidemics and the associated health risks. This quiz covers essential information on influenza's contagious nature and its public health significance.

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