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Volume 17, Number 4—April 2011

CME ACTIVITY

H275Y Mutant Pandemic (H1N1) 2009 Virus in Immunocompromised Patients

Earning Medscape CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association's Physician's Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit is acceptable as evidence of participation in CME activities. If you are not licensed in the US and want to obtain an AMA PRA CME credit, please complete the questions online, print the certificate and present it to your national medical association.

H275Y Mutant Pandemic (H1N1) 2009 Virus in Immunocompromised Patients

Medscape CME Questions

1. You are seeing a 50-year-old man being treated for acute myeloid leukemia. He complains of 3 days of fever, chills, fatigue, and wet cough. You suspect influenza, which has been more prevalent in your area over the last month, but you are concerned regarding possible antiviral resistance in this high-risk patient. Which of the following statements regarding the clinical characteristics of patients in the current study who have resistant pandemic (H1N1) 2009 is most accurate?

A. Only adults, not children, had pandemic (H1N1) 2009 with the H275Y mutation

B. Most cases of resistant pandemic (H1N1) 2009 were generated from contact with other infected patients

C. Most cases of resistant pandemic (H1N1) 2009 were diagnosed more than 5 days after the onset of symptoms

D. Lymphopenia was present in nearly half of patients with the H275Y mutation

2. A rapid polymerase chain reaction (PCR) test is positive for the patient in question number 1. Which of the following statements regarding outcomes of patients with the H275Y mutation in the current study is most accurate?

A. No patients died

B. The H275Y mutation was associated with higher levels of virulence

C. Viral shedding was prolonged, even after clinical recovery

D. No patient receiving only oseltamivir experienced clinical recovery

3. What was the rate of mutation development among all infected patients in the current study?

A. 4%

B. 16%

C. 28%

D. 50%

4. Which of the following statements regarding the virology of cases in the current study is most accurate?

A. Pandemic (H1N1) 2009 was detected in all tissues in the patient with the most severe illness

B. There was generally no discrepancy between genotyping from nasal wash and bronchoalveolar lavage samples

C. The combination of oseltamivir plus rimantadine prevented the development of the H275Y mutation

D. The initial viral load had no effect on the emergence of resistance

Activity Evaluation

1. The activity supported the learning objectives.
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2. The material was organized clearly for learning to occur.
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3. The content learned from this activity will impact my practice.
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4. The activity was presented objectively and free of commercial bias.
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