C4 IHS 2026

EASY ROUND

CASE # 1

Multiple Choice

Which of the following risk factors likely contributed to the severity of this patient’s influenza A and RSV co-infection leading to acute respiratory failure?

• A. Advanced age and lack of influenza vaccination

• B. History of thyroidectomy in the 1990s

• C. Mild hypercapnia on ABG post-intubation

• D. Negative blood and sputum cultures

Multiple Choice

Which of the following management steps in this patient aligns with current best practices for severe viral pneumonia with acute respiratory failure?

• A. Routine empiric antibiotics continued regardless of culture results

• B. Early oseltamivir initiation for confirmed influenza infection

• C. Immediate corticosteroid therapy for all viral pneumonia patients

• D. Avoidance of ventilatory support despite respiratory acidosis

CASE # 2

Multiple Choice

Which underlying factor most likely contributed to the development of severe ARDS in this patient with Influenza A infection?

• A. Age 53 years

• B. History of asthma, diabetes, hypertension, and prior severe COVID-19

• C. Recent travel from Alaska to the Philippines

• D. Early use of albuterol MDI

Multiple Choice

Which management step aligns with current best practices for severe viral pneumonia leading to ARDS?

• A. Avoid intubation and provide supplemental oxygen only

• B. Lung-protective mechanical ventilation strategy and early antiviral therapy with oseltamivir

• C. Routine broad-spectrum antibiotics in all cases regardless of cultures

• D. Immediate corticosteroid therapy in all ARDS patients

CASE # 3

Multiple Choice

Which of the following clinical features best supports the diagnosis of RSV-associated severe laryngotracheitis in this patient?

• A. Productive cough with yellowish sputum

• B. Hoarseness, intermittent loss of voice, and stridor/airway obstruction

• C. Mild desaturation on room air without airway compromise

• D. Fibroid densities in the right upper lobe on chest X-ray

Multiple Choice

Which management intervention was critical for ensuring airway patency in this patient with severe RSV laryngotracheitis?

• A. Early oral antibiotics alone

• B. High-dose nebulized albuterol only

• C. Tracheostomy following airway edema and obstruction

• D. Routine corticosteroids without airway monitoring

BONUS (EASY)

Multiple Choice

What Tagalog term is commonly used for influenza?

• A. Pamamalat

• B. Love-nut

• C. Tamar-itis

• D. Trangkaso

Multiple Choice

In the original Resident Evil games and movies, the Umbrella corporation created a virus that caused a mutagenic plague of reanimated zombies. Which is the main virus that had an outbreak in Raccoon city?

• A. Z-virus

• B. T-virus

• C. A88-virus

• D. CY-virus

AVERAGE ROUND

Multiple Choice

Which respiratory virus is currently the most prevalent cause of respiratory tract infections worldwide based on data up to 2022?

• A. Influenza virus

• B. Respiratory syncytial virus (RSV)

• C. Enterovirus/Rhinovirus

• D. Human metapneumovirus

Multiple Choice

Compared with infection by a single virus, co-infection with RSV and influenza is MOST strongly associated with which outcome?

• A. Lower hospitalization rates

• B. Reduced need for mechanical ventilation

• C. Increased ICU admission and mortality

• D. Shorter length of hospital stay

Multiple Choice

Which diagnostic test is currently preferred for the detection of respiratory viral infections in acute clinical settings?

• A. Viral culture

• B. Serologic testing

• C. Antigen detection assays

• D. Nucleic acid amplification tests (NAATs)

Multiple Choice

Which of the following is a key limitation of nucleic acid amplification tests (NAATs) for respiratory viral infections?

• A. Poor sensitivity in immunocompromised patients

• B. Inability to detect multiple pathogens simultaneously

• C. Inability to distinguish active infection from residual viral shedding

• D. High risk of contamination due to manual processing

Multiple Choice

According to the 2024 WHO guidelines, which antiviral is conditionally recommended for non-severe influenza in high-risk patients when given within 48 hours of symptom onset?

• A. Oseltamivir

• B. Baloxavir

• C. Zanamivir

• D. Peramivir

BONUS (AVERAGE)

Multiple Choice

Between 1918 and 1920, a devastating influenza pandemic infected nearly 500 million people worldwide and caused an estimated 20–50 million deaths. This global outbreak became known as the Spanish flu.

Which subtype of influenza A virus is responsible for this pandemic?

• A. 3N1+1

• B. H1N1

• C. H3N2

• D. 2NE1

Multiple Choice

Which 2004 Britney Spears hit song includes the lyric,

“Too high, can’t come down… it’s in the air and it’s all around,”

which can also be linked to or describe how a virus spreads?

• Oops! I Did It Again

• Gimme More

• Toxic

• Baby One More Time

DIFFICULT ROUND

Multiple Choice

Which of the following statements regarding RSV treatment in adults is MOST accurate?

• A. Oseltamivir is the first-line treatment

• B. Ribavirin is routinely recommended for all adults with RSV pneumonia

• C. Management is primarily supportive, with ribavirin considered only in select 

• D. Corticosteroids are strongly recommended for all RSV lower respiratory tract infections

Multiple Choice

In patients with viral pneumonia–associated ARDS requiring invasive mechanical ventilation, which ventilatory strategy is recommended?

• A. High tidal volume ventilation (10–12 mL/kg)

• B. Low tidal volume ventilation (~6 mL/kg ideal body weight)

• C. Routine corticosteroid administration in all cases

• D. Empiric broad-spectrum antibiotics

Multiple Choice

Which of the following statements about influenza vaccination in adults is correct?

• A. Annual influenza vaccination is only recommended for adults over 65 years.

• B. Influenza vaccination prevents infection but does not reduce disease severity in breakthrough cases.

• C. Annual influenza vaccination is recommended for all adults ≥19 years, with emphasis on high-risk groups.

• D. Influenza vaccination has minimal impact on hospitalizations or deaths.

Multiple Choice

Regarding RSV vaccination in adults, which is TRUE?

• A. RSV vaccination is recommended only for children.

• B. RSV vaccination reduces hospitalizations by up to 75% in adults ≥65 years.

• C. Adults aged 50–74 without comorbidities are universally recommended to get RSV vaccination.

• D. RSV vaccination has no effect on serious RSV illness in older adults.

Multiple Choice

Who should receive pneumococcal vaccination according to current adult guidelines?

• A. All adults aged ≥50 years and adults 19–49 with chronic medical conditions

• B. Only adults aged ≥65 years

• C. Adults without chronic disease until age 70

• D. Only immunocompromised adults

BONUS (DIFFICULT)

Multiple Choice

Respiratory syncytial virus (RSV) was first identified in 1956 but was not initially linked to human respiratory disease. Before its discovery in humans, it was known by a different name.

What was the original name of RSV when it was first identified?

• A. Chimpanzee coryza agent

• B. Iron lung flu virus

• C. Steeple virus

• D. Ostania-Desmond flu

Multiple Choice

Which South Korean fictional disaster movie in 2013, written and directed by Kim Sung-su, tells a tale about the sudden outbreak of a deadly airborne H5N1 virus in Bundang, South Korea which throws the region in chaos and panic?

• A. The Beat

• B. The Outbreak

• C. The Flu

• D. The Contagion