Infectious Diseases Influenza Infection: Review Questions Kenneth M. Sosnowski, PhD, ABMM Dr. Sosnowski is Assistant Professor of Pathology, University of Virginia School of Medicine, Charlottesville, VA; and Chief, Clinical Microbiology Laboratory, Veterans Affairs Medical Center, Salem, VA. Stephanie Nagy-Agren, MD Dr. Nagy-Agren is Assistant Professor of Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA;  and Chief, Division of Infectious Diseases, Veterans Affairs Medical Center, Salem, VA. Choose the single best answer for each question.
	1. All of the following statements regarding antigenic variation of the influenza virus are correct EXCEPT: Antigenic shift results from genetic reassortment and results in marked changes in the hemagglutinin or neuraminidase antigens. Antigenic variation occurs frequently in influenza A virus. Antigenic drift refers to minor changes within an influenza subtype resulting from a mutation affecting the RNA segment coding for hemagglutinin or neuraminidase. The occurrence of a herald wave at the end of a season predicts a pandemic. Swine accepts both avian and human influenza viruses and is the likely intermediate source for genetic reassortment. Click here to compare your answer. 2. All of the following statements regarding amantadine and rimantadine are correct EXCEPT: A dose reduction is recommended for persons 65 years of age or older. The incidence of central nervous system side effects is higher among persons taking amantadine than among those taking rimantadine. When amantadine or rimantadine is administered as chemoprophylaxis, vaccination is unnecessary. Both drugs are 70% to 90% effective in preventing illness caused by naturally occurring strains of influenza A virus, but they do not prevent subclinical infection. Amantadine-resistant viruses are usually cross-resistant to rimantadine and vice versa. Click here to compare your answer.		3. All of the following statements regarding the neuraminidase inhibitors zanamivir and oseltamivir are correct EXCEPT: They are effective only against influenza A viruses. They reduce the duration of illness when initiated within 48 hours of illness onset. They are sialic acid analog inhibitors of neuraminidase. They do not cause central nervous system side effects. They do not impair the humoral immune response to infection. Click here to compare your answer. 4. Each of the following conditions is a recognized complication of influenza virus infection EXCEPT: Influenza viral pneumonia Gastroenteritis Reye’s syndrome Secondary bacterial pneumonia Croup Click here to compare your answer. 5. During an influenza outbreak in your community, a 10-year-old child with a history of asthma presents to the clinic. The child has a 24-hour history of shortness of breath, a nonproductive cough, rhinorrhea, fever, and myalgias. Bronchodilators partially improved the child’s breathing at home. All of the following are an appropriate part of acute management EXCEPT: Place on droplet precautions. Initiate nebulized bronchodilator treatments. Administer amantadine until 48 hours after symptoms have resolved. Administer oxygen if oxygen saturation is low. Administer aspirin for relief of fever. Click here to compare your answer.
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