Question 1
Question
The common cold is a self [blank_start]limiting[blank_end] illness (2 days - 2 weeks), characterised by nasal [blank_start]discharge[blank_end] and a sore [blank_start]throat[blank_end]. It is caused by [blank_start]viruses[blank_end], predominantly rhinoviruses. No treatment is required, but [blank_start]symptomatic[blank_end] relief is available. Complications in the elderly, young, and immunocompromised could be [blank_start]pneumonia and asthma attacks[blank_end].
Question 2
Question
A sore throat may be pharyngitis/tonsillitis. This can be viral or bacterial.
1. Viral: 80-90% of cases attribute to [blank_start]adenoviruses[blank_end]. A mild, self-limiting infection presenting with a [blank_start]sore[blank_end] throat, and [blank_start]slight[blank_end] fever. No treatment required except for [blank_start]symptom[blank_end] relief.
2. Bacterial: A more [blank_start]severe[blank_end] infection. The most common cause of bacterial throat infection is Group A [blank_start]Streptococcus pyogenes[blank_end] (GAS). Presents with a sore throat, [blank_start]fever[blank_end], and aching, swollen [blank_start]lymph[blank_end] nodes. Diagnosis is by throat [blank_start]culture[blank_end] and treatment is [blank_start]antibiotics[blank_end]. Common complications: abscess and [blank_start]rheumatic[blank_end] fever.
Answer
-
adenoviruses
-
slight
-
sore
-
symptom
-
severe
-
Streptococcus pyogenes
-
lymph
-
fever
-
culture
-
antibiotics
-
rheumatic
Question 3
Question
Diphtheria is a serious throat infection caused by [blank_start]Corynebacterium diphtheriae[blank_end]. It presents with a sore throat, headache, greatly [blank_start]enlarged[blank_end] cervical lymph nodes, low grade [blank_start]fever[blank_end], and [blank_start]grey[blank_end] mucus on tonsils.
There is a gradual onset over [blank_start]2-5[blank_end] days, and it is transmissible for up to [blank_start]4[blank_end] weeks. It is [blank_start]toxin[blank_end] producing which causes heart & kidney [blank_start]failure[blank_end]. Prompt treatment with diphtheria [blank_start]anti-toxin[blank_end] is required & [blank_start]antibiotics[blank_end] are given even before confirmation by culture. 1 in [blank_start]10[blank_end] will still die from it. The last case in NZ was in 1998.
There has been a vaccine available since 1926, which has been on the NZ immunisation schedule since 1941. It is a [blank_start]toxoid[blank_end] vaccine given as an intramuscular injection, between 87-98% effective in generating anti-toxin [blank_start]IgG[blank_end], though it declines with time, and boosters necessary & recommended at [blank_start]45 and 65[blank_end]. The vaccine is [blank_start]funded[blank_end] but not the administration. [blank_start]Pregnant[blank_end] women are funded.
Question 4
Question
Whooping cough, also known as [blank_start]pertussis[blank_end], is caused by a highly infectious (via [blank_start]droplets[blank_end]), and [blank_start]toxin[blank_end] producing bacteria, the gram negative bacilli Bordetella pertussis. It causes airway [blank_start]inflammation & oedema[blank_end], and airway [blank_start]cell[blank_end] death. The most at risk are [blank_start]infants[blank_end] too young to be immunised; Complications – pneumonia, convulsions, brain damage, death. 1 in 6 infants will [blank_start]die[blank_end] or have [blank_start]brain or lung[blank_end] damage.
For adults and children, [blank_start]12-37[blank_end]% of persistent coughs are pertussis.
There are [blank_start]2-5[blank_end] yearly epidemics. The highest rates are in Pacific and Māori
infants, with [blank_start]51[blank_end]% hospitalized. There is a 4-fold increased risk of hospitalizations for children living in in [blank_start]deprived[blank_end] conditions.
Answer
-
pertussis
-
droplets
-
toxin
-
inflammation & oedema
-
cell
-
infants
-
die
-
brain or lung
-
12-37
-
2-5
-
51
-
deprived
Question 5
Question
Stages of Whooping Cough:
After a [blank_start]7-10[blank_end] day incubation -
• Stage 1 - ([blank_start]1[blank_end] week) malaise, low grade [blank_start]fever[blank_end], sneezing, runny [blank_start]nose[blank_end],
dry [blank_start]cough[blank_end]. The [blank_start]most[blank_end] infectious stage. Antibiotic treatment at this stage
can [blank_start]decrease[blank_end] severity of stage 2. Contacts should also be [blank_start]treated[blank_end].
• Stage 2 - ([blank_start]4[blank_end] weeks) short burst of extreme paroxysmal coughing
(accumulation of [blank_start]mucus[blank_end]), vomiting, feeling of [blank_start]choking[blank_end], “whooping”
between coughing fits. Still infectious, and [blank_start]few[blank_end] symptoms between
paroxysms. Treatment here will not effect the disease but reduces [blank_start]transmission[blank_end].
• Stage 3 - ([blank_start]6[blank_end] weeks - months) recovery, cough less often.
Prevention:
- Vaccine available since 1945, on NZ immunisation schedule since 1960, i.m. injection
- Moved from a cell-based vaccine to an [blank_start]acellular[blank_end] pertussis vaccine in
the 1990s – less [blank_start]reactogenic[blank_end] but less effective. Boosters are required & funded.
- It is recommended, but not funded that contacts & carers of [blank_start]newborns[blank_end] get boosters.
Answer
-
7-10
-
1
-
4
-
6
-
fever
-
nose
-
cough
-
most
-
decrease
-
treated
-
mucus
-
choking
-
few
-
transmission
-
acellular
-
reactogenic
-
newborns
Question 6
Question
Influenza is an acute, self-limiting infection of the respiratory tract, causing fever, malaise, a sore throat, [blank_start]dry[blank_end] cough, and [blank_start]headache[blank_end].
It is caused by [blank_start]orthomyxovirus[blank_end] which has an RNA genome and 2 major surface [blank_start]glycoproteins[blank_end]; [blank_start]Haemagglutinin[blank_end] (H) and [blank_start]neuraminidase[blank_end] (N).
There are 3 types of influenza viruses - A, B and C:
A - evolves [blank_start]quickly[blank_end], causes [blank_start]human[blank_end] epidemics & pandemics, [blank_start]severe[blank_end] disease, H/N subtypes
B - no H/N [blank_start]subtypes[blank_end], evolves more [blank_start]slowly[blank_end] than A, causes disease in humans, usually [blank_start]less[blank_end] severe
C - no H/N subtypes, no disease in [blank_start]humans[blank_end]
Answer
-
headache
-
dry
-
orthomyxovirus
-
glycoproteins
-
Haemagglutinin
-
neuraminidase
-
quickly
-
human
-
severe
-
subtypes
-
slowly
-
less
-
humans
Question 7
Question
Individuals can get influenza many times during life because the virus is continuously mutating.
Question 8
Question
Antigenic [blank_start]drift[blank_end] of the influenza virus causes seasonal variants.
It occurs to overcome the [blank_start]antibodies[blank_end] blocking the H glycoproteins ability to bind to [blank_start]cells[blank_end]. It is a [blank_start]mutation[blank_end] of the H epitopes so that the antibody [blank_start]cannot[blank_end] bind and the virus may bind to the cell instead.
Antigenic [blank_start]shift[blank_end] of the influenza virus causes epidemic/pandemic variants.
It occurs when two viral strains exchange [blank_start]RNA[blank_end] segments in a [blank_start]secondary[blank_end] host and a [blank_start]novel[blank_end] H is formed.
Answer
-
drift
-
shift
-
antibodies
-
antigens
-
cells
-
viruses
-
mutation
-
copy
-
cannot
-
can
-
shift
-
drift
-
RNA
-
DNA
-
secondary
-
primary
-
novel/new
-
defective
Question 9
Question
Treatment for influenza is typically [blank_start]symptomatic[blank_end] relief of fever and pain with [blank_start]OTC[blank_end] meds.
We can also use:
1. [blank_start]M2 Ion Channel[blank_end] Inhibitors (Cyclic Amines or Adamantanes) - amantadine, rimantadine: Inhibit viral [blank_start]uncoating[blank_end], which is symptomatic relief. Does not stop viral [blank_start]shedding[blank_end]. Has systemic [blank_start]toxicities[blank_end] and is associated with rapid induction of [blank_start]resistant[blank_end] viruses.
2. [blank_start]Neuraminidase[blank_end] inhibitors eg oseltamivir (Tamiflu) & zanamivir (Relenza): [blank_start]Pharmacist only[blank_end] medicine in NZ. Symptomatic relief via [blank_start]decrease[blank_end] of viral shedding, which reduces the [blank_start]rate of complications[blank_end]. May stop protective [blank_start]immune[blank_end] response developing. Has toxicities (especially [blank_start]zanamivir[blank_end]), and will induce viral resistance (especially [blank_start]oseltamivir[blank_end]). There is [blank_start]weak[blank_end] evidence that it may reduce mortality, hospitalisation and duration of symptoms, compared with no treatment.
Answer
-
symptomatic
-
OTC
-
M2 Ion Channel
-
Neuraminidase
-
uncoating
-
shedding
-
toxicities
-
resistant
-
Pharmacist only
-
decrease
-
rate of complications
-
immune
-
zanamivir
-
oseltamivir
-
weak
Question 10
Question
Seasonal influenza prevention:
- [blank_start]Inactivated[blank_end] vaccines against 3 or 4 circulating strains available – the supplier varies from year to year
- Usually an intramuscular vaccine, which is [blank_start]funded[blank_end], effectiveness is [blank_start]~50[blank_end]%?
- Funded in pharmacy for over [blank_start]65[blank_end]’s
Pandemic influenza prevention:
- H1N1 pandemic strain – now included in [blank_start]seasonal[blank_end] vaccine
- H5N1 vaccine – Focetria® (Novartis), etc
- H7N9 – pre-pandemic vaccines have been made by reverse genetics,
not publicly available but [blank_start]stockpiles[blank_end] exist
Answer
-
Inactivated
-
funded
-
~50
-
65
-
seasonal
-
stockpiles