Midterm Vaccines Test Bank
A 20-year-old college student reports to the student health clinic with a laceration of her left hand. She tells the nurse practitioner that she cut her hand while working in her garden. Her last Td booster was 5½ years ago. Which of the following is correct? A) Administer a booster dose of the Tdap vaccine B) Administer the Td vaccine and the Td immunoglobulin (HyperTET) C) Administer Td immunoglobulin (HyperTET) only D) She does not need any Td immunoglobulin (HyperTET) or a Td booster
A) Administer a booster dose of the Tdap vaccine The Centers for Disease Control and Prevention (CDC) recommends the Tdap for teens or adults who need a Td booster (once in a lifetime). A tetanus vaccine booster is recommended for recent injuries if it has been more than 5 years since the last dose.
All of the following statements are correct regarding the Td vaccine except: A) Fever occurs in up to 80% of the patients B) A possible side effect is induration on the injection site C) The Td is given every 10 years D) The DPT and DT should not be given beyond the seventh birthday
A) Fever occurs in up to 80% of the patients Side effects of the Td vaccine include induration at the injection site. Td is given in adults every 10 years. The DPT and DT should not be given beyond 7 years of age. Fever may occur, but studies do not support 80% of patients having fever.
The anti-HCV test of a 60-year-old female patient is positive. Which test is appropriate for follow-up? A) HCV RNA B) HCV antibody C) HCV core antibody D) HCV surface antigen
A) HCV RNA The anti-HCV test detects the presence of antibodies to the hepatitis C virus, indicating exposure to HCV. The anti-HCV test cannot distinguish between someone with active or previous HCV infection (reported as positive or negative). The HCV RNA test is qualitative and used to distinguish between a current or past infection. It is reported as "negative" or "not detected." It may also be ordered after treatment is complete to see whether the virus has been eliminated.
All of the following vaccines are contraindicated in pregnant women except: A) Influenza B) Mumps C) Varicella D) Rubella
A) Influenza Not all vaccinations are safe to get during pregnancy. However, the flu vaccine can be given before, during, and after pregnancy. The other vaccines are live viruses and are contraindicated during pregnancy.
Human papillomavirus (HPV) infection of the larynx has been associated with: A) Laryngeal cancer B) Esophageal stricture C) Cervical cancer D) Metaplasia of the squamous cells
A) Laryngeal cancer Human papillomavirus (HPV) exposure is a risk factor in laryngeal cancer. HPV DNA transforms the moist membranes of epithelial cells (cervix, anus, mouth, and throat). The juvenile type is related to vertical transmission and the adult type to orogenital contact. HPV subtype 16 accounts for the majority of oral tumors, oropharynx cancers, and laryngeal cases.
A 14-year-old girl who is sexually active is brought to the health clinic by her mother for an immunization update. According to the mother, her daughter has had one dose of hepatitis B vaccine. Which of the following vaccines would you administer at this visit? A) Tdap, hepatitis B, and HPV vaccine B) DTaP (diphtheria, tetanus, acellular pertussis) and hepatitis B C) Hepatitis B only D) MMR (measles, mumps, rubella), Td, and HPV vaccine
A) Tdap, hepatitis B, and HPV vaccine There are two types of HPV vaccine. Gardasil can be used for both girls and boys, but Cervarix can only be used for females. HPV vaccine is recommended for preteen boys and girls at age 11 or 12 years. Young women can get HPV vaccine until age 27 years and men can get the HPV vaccine until age 22 years.
A newborn's mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant? A) Give the infant hepatitis B immunoglobulin B) Give the infant both hepatitis B vaccine and hepatitis B immunoglobulin C) Give the infant hepatitis B vaccine only D) Send the infant home because he is not infected
B) Give the infant both hepatitis B vaccine and hepatitis B immunoglobulin For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection.
A patient is positive for anti-HCV (hepatitis C virus antibody). What is the next step to further evaluate this patient? A) Refer the patient to a gastroenterologist B) Order a hepatitis C RNA test C) Order a hepatitis B comprehensive panel D) The patient is immune to hepatitis C and no further testing is indicated
B) Order a hepatitis C RNA test When a patient tests positive for anti-HCV (hepatitis C virus antibody), the follow-up test recommended by the CDC is the hepatitis C RNA test. The majority of patients with hepatitis C infection have chronic infection.
You would advise an 18-year-old female student who has been given a booster dose of MMR at the college health clinic that: A) She might have a low-grade fever during the first 24 to 48 hours B) She should not get pregnant within the next 4 weeks C) Her arm will be very sore at the injection site for 24 to 48 hours D) Her arm will have some induration at the injection site in 24 to 48 hours
B) She should not get pregnant within the next 4 weeks MMR should not be administered to women known to be pregnant. In addition, women should be counseled to avoid becoming pregnant for 28 days following vaccination.
A 13-year-old adolescent girl is brought to the health clinic by her mother for a sports physical. The mother reports that the teen's last vaccines were given at the age of 6 years. Which of the following vaccines is recommended by the Centers for Disease Control and Prevention (CDC) for this patient? A) Td and HPV vaccines B) Tdap, MCV4, and the HPV vaccines C) DTap and the flu vaccine D) DT and MCV4 vaccines
B) Tdap, MCV4, and the HPV vaccines Vaccine questions usually are not this complicated, but there are several lessons that can be learned with this question. The 2017 Centers for Disease Control and Prevention (CDC) recommendations for individuals 13 to 18 years of age are the Tdap catch-up (if not received at age 11-12 years), human papillomavirus (HPV) catch-up (if not received at age 11-12 years), and the MCV4 or meningococcal conjugate vaccine (Menactra). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP (diphtheria-tetanus- acellular pertussis) and DT (diphtheria-tetanus) forms of the tetanus vaccine are not given after the age of 7 years.
The mother of a 4-month-old girl calls your office and reports that the infant has a fever of 101.4°F. The infant received her immunizations yesterday. Which of the following is correct? A) The fever is most likely due to the combination of the MMR and polio vaccines B) The fever is most likely due to the pertussis component of the DTaP vaccine C) The infant is probably starting a viral upper respiratory infection D) The infant had an allergic reaction to one of the vaccines given and should be brought to the emergency department
B) The fever is most likely due to the pertussis component of the DTaP vaccine The pertussis component of the vaccine is most likely the cause of the fever.
The following statements are all true regarding herpes zoster except: A) It is due to reactivation of latent varicella virus B) The typical lesions are bullae C) It is usually more severe in immunocompromised individuals D) Infection of the trigeminal nerve ophthalmic branch can cause corneal blindness
B) The typical lesions are bullae Herpes zoster (shingles) occurs secondary to reactivation of the varicella-zoster (VZV) virus. This infection can be more severe in immunocompromised patients due to their inability to fight infection. Shingles rash starts as small blisters on a red base, with new blisters continuing to form for 3 to 5 days. The rash is painful, and commonly appears in clusters, following one dermatome on one side of the body. When the trigeminal nerve is involved, there is an increased risk of corneal blindness.
Human papillomavirus infection in women has been associated with the development of: A) Ectopic pregnancy B) Infertility C) Cervical cancer D) Pelvic inflammatory disease
C) Cervical cancer There are more than 30 types of human papillomavirus (HPV). HPV types in the anogenital region have been strongly associated with lowgrade and high-grade cervical change, cervical neoplasia, as well as anogenital and other cancers. An HPV vaccine is recommended for girls and boys between the ages of 15 and 21 years of age to help prevent four strains of this virus.
A 19-year-old woman has recently been diagnosed with acute hepatitis B. She is sexually active and is monogamous. She reports that her partner uses condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (−), anti-HBs (−), antiHCV (−), anti-HAV (+)? A) Hepatitis B vaccination B) Hepatitis B immunoglobulin C) Hepatitis B vaccination and hepatitis B immunoglobulin D) No vaccination is needed at this time
C) Hepatitis B vaccination and hepatitis B immunoglobulin Hepatitis B surface antigen (HBsAg) is a marker of infectivity. If positive, it indicates either an acute or a chronic hepatitis B infection. Antibody to hepatitis B surface antigen (anti-HBs) is a marker of immunity. Antibody to hepatitis B core antigen (anti-HBc) is a marker of acute, chronic, or resolved hepatitis B virus (HBV) infection; it may be used in prevaccination testing to determine previous exposure to HBV. The hepatitis B panel results for the individual in this question (negative HBsAg, anti-HBc, and antiHBs) indicates the partner is susceptible (not immune), has not been infected, and is still at risk of future infection—and thus needs vaccine. Interpretation of the negative hepatitis C anti-HCV screening test indicates that the partner is not infected. Hepatitis B immunoglobulin contains antibodies that provide "instant" immunity against hepatitis B, but its action lasts for several days, only. It is not a vaccine. It is given to infants and others who are at high risk of becoming infected and are not immune. The hepatitis B vaccine stimulates the body to make its own antibodies, which are permanent. A total of three doses are needed to gain full immunity against hepatitis B.
A 65-year-old woman comes into the clinic during the first week of November for her annual wellness visit. Her last Td booster was 9 years ago. Which immunization(s) would you recommend for this visit? A) Influenza vaccine only B) Tetanus and influenza vaccine C) Pneumococcal (Pneumovax) and influenza vaccines D) She does not need any vaccinations to be administered in this visit
C) Pneumococcal (Pneumovax) and influenza vaccines The tetanus (Td) immunization is good for about 10 years. October/November is the beginning window of the flu season, and annual influenza vaccination is recommended. The pneumococcal (pneumonia) vaccine is indicated for patients older than 65 years.
A sexually active 22-year-old man is asking to be screened for hepatitis B because his new girlfriend has recently been diagnosed with hepatitis B infection. His lab results are the following: anti-HBV is negative, HBsAg is positive, and HBeAg is negative. Which of the following is true? A) The patient is immune to the hepatitis B virus B) The patient is not infected with hepatitis B virus C) The patient needs hepatitis B vaccine and hepatitis B immunoglobulin D) The patient needs only hepatitis B immunoglobulin
C) The patient needs hepatitis B vaccine and hepatitis B immunoglobulin Because he is HBsAg positive, and anti-HBV and HBeAg negative, he needs hepatitis B immunoglobulin and hepatitis B vaccine.
In small children with acquired immunodeficiency syndrome (AIDS), which of the following vaccines is contraindicated? A) Diphtheria and tetanus (Td) B) Hepatitis B and mumps C) Varicella D) Td and oral polio
C) Varicella The data regarding efficacy of the varicella vaccine are insufficient; therefore, varicella vaccine is contraindicated in HIV-infected individuals.
The earliest age at which the MMR vaccine can be administered is: A) 4 months B) 6 months C) 8 months D) 12 months
D) 12 months The earliest age at which MMR vaccination should be given is 12 months. Giving the vaccine any earlier may be less effective because the infant still has antibodies from the mother, which may interfere with the production of the antibodies stimulated by the vaccine.
A 15-year-old boy has just moved into the community and is staying in a foster home temporarily. There is no record of his immunizations. His foster mother wants him to be checked before he enters the local high school. Which of the following immunizations does this patient need? A) Meningococcal vaccine B) Measles-mumps-rubella (MMR) vaccine C) Tdap vaccine D) All of the above
D) All of the above This 15-year-old teenage patient will follow the Centers for Disease Control and Prevention (CDC) "catch-up" schedule (CDC, 2017) and needs the meningococcal vaccine, MMR vaccine, and Tdap vaccine. In addition to these three vaccines, this patient needs the hepatitis B vaccine, human papillomavirus (HPV) vaccine, and varicella vaccine (if no history of chickenpox).
Which type of hepatitis virus infection is more likely to result in chronic hepatitis and increased risk of developing hepatocellular carcinoma? A) Hepatitis A virus B) Hepatitis B virus C) Hepatitis C virus D) Both hepatitis B and hepatitis C
D) Both hepatitis B and hepatitis C Of the primary hepatitis viruses, only B and C are associated with hepatocellular cancer. Chronic hepatitis B and C infection often results in cirrhosis of the liver, which increases the risk of liver cancer.
A 5-year old boy is in your office for a school physical. The mother denies a history of chickenpox infection. Which of the following immunizations is indicated at this visit? A) Tdap, IPV, MMR B) DTaP, Hib, PCV, IPV C) MMR, hepatitis B, varicella D) DTaP, IPV, MMR, varicella
D) DTaP, IPV, MMR, varicella The best clue is that the mother denies a history of chickenpox infection; therefore, this child requires the varicella vaccine. Only two answer options include varicella. The child does not need hepatitis B vaccination.
An Rh-negative pregnant woman with negative rubella titers can be vaccinated at what time in pregnancy? A) At any time in pregnancy B) During the second trimester C) During the third trimester D) During the postpartum period
D) During the postpartum period The measles, mumps, and rubella (MMR) vaccine is contraindicated in pregnancy. The Advisory Committee on Immunization Practices recommends that pregnancy be avoided for 4 weeks after vaccination, that women who become pregnant within that period be advised of the theoretical risk to the fetus (congenital rubella syndrome), and that vaccination during pregnancy is generally not a reason to terminate the pregnancy
You would recommend the pneumococcal vaccine (Pneumovax) to patients with all of the following conditions except: A) Sickle cell anemia B) Splenectomy C) HIV infection D) G6PD-deficiency anemia
D) G6PD-deficiency anemia Pneumococcal vaccine is not indicated for glucose-6-phosphate dehydrogenase (G6PD)-deficiency anemia. There two types of pneumonia vaccine for adults: PPSV23 (Pneumovax 23) and PCV13 (Prevnar 13). Pneumococcal vaccine is recommended for individuals beginning at age 65 years, but the two types should not be given together. The Centers for Disease Control and Prevention (CDC) recommends administering Prevnar 13 first, then waiting at least 1 year (12 months) and giving the Pneumovax. The immunogenic response is better using this method. Prevnar 13 is recommended for all infants and children younger than 2 years of age, all adults aged 65 years or older, and people (2 to 64 years old) with certain medical conditions that increase risk of pneumococcal disease, such as functional or anatomic asplenia (sickle cell), HIV infection, chronic renal failure, leukemia, heart failure, cyanotic congenital heart disease, chronic lung disease (asthma, chronic obstructive pulmonary disease [COPD]), diabetes, and others.
A 45-year-old gardener is seen as a walk-in patient in a private clinic. He reports stepping on a nail that morning. His last tetanus vaccine was 7 years ago. Which of the following vaccines is recommended? A) DTaP B) DT C) Td D) Tdap
D) Tdap The Centers for Disease Control and Prevention (CDC) recommends that one of the tetanus boosters be replaced with the Tdap (once in a lifetime). Thereafter, the Td form of the vaccine is indicated every 10 years. The DTaP (diphtheria-tetanus-acellular pertussis) and DT (diphtheria-tetanus) forms of the tetanus vaccine are not given after the age of 7 years. Puncture wounds are at higher risk for tetanus because Clostridium tetani bacteria are anaerobes (deep puncture wounds are not exposed to air compared with superficial wounds).
