Respiratory Syncytial Virus (RSV)

Respiratory Syncytial Virus (RSV)

Q. 1 Which of the following antiviral agents is a purine   nucleoside   analogue   that   has   shown promise with Lassa fever, influenza A and B, and respiratory syncytial virus (RSV).
 A Amantadine
 B Rimantadine
 C Vidarabine 
 D Ribavirin
 
Q. 1 Which of the following antiviral agents is a purine   nucleoside   analogue   that   has   shown promise with Lassa fever, influenza A and B, and respiratory syncytial virus (RSV).
 A Amantadine
 B Rimantadine
 C Vidarabine 
 D Ribavirin
 
Ans. D

Explanation:

As  an  intravenous  agent,  ribavirin  is  effectiveagainst Lassa fever in the first week of onset of the disease. It may also be administered as an aerosol that is quite useful in infants with RSV. Unlike amantadine, which is efficacious only with influenza A, ribavirin has activity against both influenza A and B if administered by aerosol in the first 24 h of onset.


Q. 2

True about Palivizumab are all, EXCEPT:

 A

Used by intramuscular route

 B

Used in treatment of RSV infection

 C

Adverse effects include upper respiratory tract infection

 D

None of the above

Q. 2

True about Palivizumab are all, EXCEPT:

 A

Used by intramuscular route

 B

Used in treatment of RSV infection

 C

Adverse effects include upper respiratory tract infection

 D

None of the above

Ans. B

Explanation:

Palivizumab is a humanized monoclonal antibody directed against an epitope in the A antigen site on the F surface protein of RSV.
 
It is licensed for the prevention of RSV infection in high-risk infants and children, such as premature infants and those with bronchopulmonary dysplasia or congenital heart disease.
A placebo-controlled trial using once-monthly intramuscular injections (15 mg/kg) for 5 months beginning at the start of the RSV season demonstrated a 55% reduction in the risk of hospitalization for RSV in treated patients, as well as decreases in the need for supplemental oxygen, illness severity score, and need for intensive care. Although resistant strains have been isolated in the laboratory, no resistant clinical isolates have yet been identified.
 
Potential adverse effects include upper respiratory tract infection, fever, rhinitis, rash, diarrhea, vomiting, cough, otitis media, and elevation in serum aminotransferase levels.
 
Ref: Katzung 11th edition Chapter 49.

Q. 3

Respiratory Syncytial Virus (RSV) causes all, EXCEPT:

 A

Coryza in kids

 B

ARDS

 C

Bronchitis

 D

Common cold

Q. 3

Respiratory Syncytial Virus (RSV) causes all, EXCEPT:

 A

Coryza in kids

 B

ARDS

 C

Bronchitis

 D

Common cold

Ans. B

Explanation:

RSV infection leads to a wide spectrum of respiratory illnesses. 

In infants it can cause pneumonia, bronchiolitis, and tracheobronchitis. In this age group, illness begins most frequently with rhinorrhea, low-grade fever, often accompanied by cough and wheezing. 
 
In adults, the most common symptoms are common cold, with rhinorrhea, sore throat, and cough. It cause severe pneumonia in elderly. 
 
Sinusitis, otitis media, and worsening of chronic obstructive and reactive airway disease are also associated with RSV infection.
 
Ref: Harrison’s Principles of Internal Medicine, 18th Edition, Chapter 186

Q. 4

A 11-month old child presents with complaints of respiratory distress. On examination there is bilateral crepitation and wheezing. Which of the following is the most likely cause?

 A

Pneumonia

 B

Adenovirus

 C

Respiratory syncytial virus

 D

Rhinovirus

Q. 4

A 11-month old child presents with complaints of respiratory distress. On examination there is bilateral crepitation and wheezing. Which of the following is the most likely cause?

 A

Pneumonia

 B

Adenovirus

 C

Respiratory syncytial virus

 D

Rhinovirus

Ans. C

Explanation:

Respiratory syncytial virus (RSV) is the most important cause of pneumonia and bronchiolitis in infants.
The classic disease is bronchiolitis, characterized by diffuse wheezing, variable fever, cough, tachypnea, difficulty feeding, and, in severe cases, cyanosis.
In severe cases, children must be hospitalized and given humidified oxygen.
 
Ref: Levinson W. (2012). Chapter 39. RNA-Enveloped Viruses. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

Q. 5

A 3 month old infant presents with a 3 day history of fever, cough, and poor feeding. On examination, the baby appears ill and has a temperature of 102 F and a respiratory rate of 32. A chest x-ray film showed bilateral patchy infiltrates in the lungs. Which of the following is the most likely etiologic agent?

 A

Coronavirus

 B

Influenza type A

 C

Parainfluenza type1

 D

Respiratory syncytial virus

Q. 5

A 3 month old infant presents with a 3 day history of fever, cough, and poor feeding. On examination, the baby appears ill and has a temperature of 102 F and a respiratory rate of 32. A chest x-ray film showed bilateral patchy infiltrates in the lungs. Which of the following is the most likely etiologic agent?

 A

Coronavirus

 B

Influenza type A

 C

Parainfluenza type1

 D

Respiratory syncytial virus

Ans. D

Explanation:

Respiratory syncytial virus is the most common cause of bronchiolitis and pneumonia in children younger than 1 year. Outbreaks occur seasonally in winter and early spring. Infection does not result in lasting immunity, and reinfection can occur.
 
Coronavirus causes the common cold (nasal obstruction and discharge, sneezing, no fever or mild fever, occasional sore throat, and/or cough) and acute pharyngitis (sore throat, with or without cervical adenopathy, ulceration, and conjunctivitis).
 
Influenza type A is the leading cause of influenza. Influenza is a systemic illness characterized by the sudden onset of fever, headache, myalgias, malaise, and prostration, followed by cough, nasal obstruction, and sore throat. The lower respiratory tract may also be involved.
 
Parainfluenza viruses are the leading cause of croup, or acute laryngotracheobronchitis, in children. This infection involves both the upper and lower respiratory tracts. Inflammation in the subglottic area leads to hoarseness, dyspnea, a barking cough, and inspiratory stridor.
 
Ref: Levinson W. (2012). Chapter 39. RNA-Enveloped Viruses. In W. Levinson (Ed),Review of Medical Microbiology & Immunology, 12e.

 

 


Q. 6

An infant develops cough and fever. The X-ray examination is suggestive of bronchopneumonia. All of the following viruses can be the causative agent, EXCEPT:

 A

Parainfluenza viruses

 B

Influenza virus A

 C

Respiratory syncytial virus

 D

Mumps virus

Q. 6

An infant develops cough and fever. The X-ray examination is suggestive of bronchopneumonia. All of the following viruses can be the causative agent, EXCEPT:

 A

Parainfluenza viruses

 B

Influenza virus A

 C

Respiratory syncytial virus

 D

Mumps virus

Ans. D

Explanation:

Mumps occur between the ages of 5 & 15. Infants are rarely involved due to presence of transplacentally acquired maternal mumps antibodies.

Ref: O P Ghai Essential Pediatrics, 6th Edition, Page 209


Q. 7

Which pathogens adhere to respiratory epithelium-

 A

RSV

 B

Influenza

 C

Parainfluenza

 D

All

Q. 7

Which pathogens adhere to respiratory epithelium-

 A

RSV

 B

Influenza

 C

Parainfluenza

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., RSV; ‘b’ i.e., Influenza; ‘c’ i.e., Parainfluenza

Viral adherence

.     In order for host infection to occur, a virus must first attach (adhere) to and enter cells of one of the body surfaces – respiratory tract, GIT, skin, urogenital tract or conjuctiva.

.     Viruses infecting respiratory tract :

–     Parvovirus                                                  – Togavirus

–     Adenovirus                                                 – Coronavirus

–    Herpesvirus (EBV, HSV)                         – Orthomyxovirus (Influenza)

–     Picornavirus (Rhinovirus)                      – Paramyxovirus (Parainfluenza, RSV)


Q. 8

The most common etiological agent for acute bronchiolitis in infancy is ‑

 A

Influenza virus

 B

Para influenza virus

 C

Rhinovirus

 D

Respiratory syncytial virus

Q. 8

The most common etiological agent for acute bronchiolitis in infancy is ‑

 A

Influenza virus

 B

Para influenza virus

 C

Rhinovirus

 D

Respiratory syncytial virus

Ans. D

Explanation:

Ans. is ‘d’ i.e., Respiratory syncytial virus

“The most common etiological agent for Bronchiolitis is Respiratory synctial virus. RSV is responsible for more than 50% of cases of bronchiolitis.”

Bronchiolitis

o Bronchiolitis is the most common serious acute lower respiratory tract infection in infants and young children. o Most vulnerable group is between the ages of 1 and 6 months.

o But the disease can affect children up to 2 years.

o More common in males.

Organisms causing bronchiolitis

o Bronchiolitis is predominantly a viral disease.

i) RSV (most common)                       ii) Parainfluenza virus 3, 1, 2             v) Mycoplasma pneumoniae

iii) Adenovirus                                 iv) Influenza virus


Q. 9

Which of the following is/are true about bronchiolitis in children –

 A

Caused by respiratory syncytial virus

 B

Hyperinflation of the chest

 C

Pleural effusion

 D

a and b

Q. 9

Which of the following is/are true about bronchiolitis in children –

 A

Caused by respiratory syncytial virus

 B

Hyperinflation of the chest

 C

Pleural effusion

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Caused by respiratory syncytial virus, ‘b’ i.e., Hyperinflation of the chest

o Bronchiolitis is caused most commonly by RSV.

o Major concerns, include not only the acute effects of bronchiolitis but also the possible development of chronic airway hyperreactivity, i.e. asthma.


Q. 10

Aerosolized ribavirin is used in the treatment of bronchiolitis with –

 A

RSV

 B

H.influenza

 C

Pneumococcus

 D

Streptococcus

Q. 10

Aerosolized ribavirin is used in the treatment of bronchiolitis with –

 A

RSV

 B

H.influenza

 C

Pneumococcus

 D

Streptococcus

Ans. A

Explanation:

Ans. is ‘a’ i.e., RSV


Q. 11

In a child 1 years the commonest cause of resp. Infection with wheeze is –

 A

RSV

 B

Influenza viurs

 C

Adenovirus

 D

Para influenza

Q. 11

In a child 1 years the commonest cause of resp. Infection with wheeze is –

 A

RSV

 B

Influenza viurs

 C

Adenovirus

 D

Para influenza

Ans. A

Explanation:

Ans. is ‘a’ i.e., RSV

o Wheezing due to respiratory tract infection in a 1 year old child is due to bronchiotilis.


Q. 12

A Bone marrow transplant receipient patient, developed chest infection. ON chest Xray Tree in Bud appearance is present. The cause of this is:

 A

Klebsiella

 B

Pneumocystis

 C

TB

 D

RSV

Q. 12

A Bone marrow transplant receipient patient, developed chest infection. ON chest Xray Tree in Bud appearance is present. The cause of this is:

 A

Klebsiella

 B

Pneumocystis

 C

TB

 D

RSV

Ans. D

Explanation:

D i.e. (RSV)

– Most common cause of tree in bud (bronchiectasis) appearance is Mycobacterium tuberculosis (endobronchial).

Most common specific cause of tree in bud appearance in HSL (bone marrow) transplant patients is CMV (30-70%) > RSV (18%) > M. tuberculosis (5-6%) > Pneumocystis > Invasive aspergillosis.

Tree in Bud appearance

6 Months) – Pneumocystis – S.pneumoniae – CMV, Seasonal respiratory virus (RSV & para influenza viruses) – Pneumocystis – Toxoplasma ” v:shapes=”_x0000_s1031″>Tree in bud appearance (or gloved finger appearance) is depiction of normally invisible branching course of intralobular bronchiole on HRCT. It indicates the endobronchial spread of disease lit bronchiolar luminal impaction with mucus, pus or fluid, bronchiolar wall thickening, peribronchiolar inflammation and dilatation of distal bronchioles. On HRCT, it appears as peripheral (within 5mm of pleural surface) small (2-4mm) centrilobular well defined nodules connected to linear branching opacities with more than one contiguous branching sites. 


Q. 13

Which myxovirus does not have hemagglutinin and neuraminidase but have membrane fusion protein –

 A

Measles

 B

Parainfluenza

 C

RSV

 D

Influenza

Q. 13

Which myxovirus does not have hemagglutinin and neuraminidase but have membrane fusion protein –

 A

Measles

 B

Parainfluenza

 C

RSV

 D

Influenza

Ans. C

Explanation:

Ans. is ‘c’ i.e., RSV

RSV does not posses hemagglutinin or neuraminidase.

The viral envelope has two glycoproteins‑

i) G protein → By which virus attaches to cell surface

ii) F- protein ( Fusion protein ) → which bring about fusion between viral and host cell membranes. It is also responsible for cell to cell fusion, which leads to characteristic syncytial formation.


Q. 14

Most common cause of viral pneumonia in infant is ‑

 A

Rhinovirus

 B

RSV

 C

Reovirus

 D

CMV

Q. 14

Most common cause of viral pneumonia in infant is ‑

 A

Rhinovirus

 B

RSV

 C

Reovirus

 D

CMV

Ans. B

Explanation:

Ans. is ‘b’ i.e., RSV

  • RSV is the most common cause of pneumonia and bronchilis in infants.
  • In adults, influenza is the most common cause of viral pneumonia.


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