Green book 5

Question 1

The disease tetanus:
a) Is caused by the action of tetanus toxin
b) Is unlikely in unvaccinated individuals in the UK as there is herd immunity
c) Can never be eradicated as the spores are common in the environment
d) Following a national vaccination programme almost disappeared in adults over 65 in
the UK by the 1970s
e) Injecting drug use is a risk factor

Answer 1

Is caused by the action of tetanus toxin

Can never be eradicated as the spores are common in the environment

Injecting drug use is a risk factor

Question 2

Tetanus vaccine:

a) Is a live attenuated vaccine
b) Contains adjuvant
c) Is available as a single antigen vaccine in the UK
d) Should not given with MMR vaccine
e) 5 doses provide long term protection

Answer 2

Contains adjuvant

5 doses provide long term protection

Question 3

Tetanus containing vaccines should not be given if:
a) There has been a confirmed anaphylactic reaction to a previous dose of a tetanus
containing vaccine
b) There has been a confirmed anaphylactic reaction to neomycin, streptomycin or
polymyxin B
c) There has been a severe reaction to a previous vaccination including persistent
crying or screaming for more than 3 hours
d) There has been a severe local reaction including swelling of the whole
circumference of the arm
e) The intended recipient is a breast-feeding woman

Answer 3

There has been a confirmed anaphylactic reaction to a previous dose of a tetanus containing vaccine

There has been a confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B

Question 4

A tetanus prone wound would include one:

a) Which requires surgery that is delayed for more than 6 hours
b) Which has a lot of devitalised tissue
c) Where there is a puncture wound contaminated with soil
d) Where there is a foreign body
e) Where there is a deep cut from a clean kitchen knife

Answer 4

Which requires surgery that is delayed for more than 6 hours

Which has a lot of devitalised tissue

Where there is a puncture wound contaminated with soil

Where there is a foreign body

Question 5

A child aged 10 who has received a total of 3 doses of tetanus vaccine sustains a
high-risk tetanus prone wound. They require:
a) Two reinforcing doses of vaccine
b) One reinforcing dose of vaccine
c) One reinforcing dose of vaccines, and one dose of Human tetanus Immunoglobulin
d) No further doses of vaccine, but one dose of Human tetanus Immunoglobulin
e) None of the above

Answer 5

One reinforcing dose of vaccines, and one dose of Human Tetanus Immunoglobulin

Question 6

Which of the following is/are true about TBE vaccine?

a) It is supplied as a suspension of 0.5ml injection in pre-filed syringe
b) It is inactivated
c) It is thiomersal tree
d) It is effective against both European and Far East subtypes
e) It can cause the disease

Answer 6

It is supplied as a suspension of 0.5ml injection in pre-filed syringe

It is inactivated

It is thiomersal free

It is effective against both European and Far East subtypes

Question 7

Which of the following is/are true about TBE vaccine?
a) It is recommended for the protection of individuals at high risk of exposure to the
virus through travel or employment
b) It is recommended particularly for spring and summer travel in warm, forested and
endemic areas, where ticks are most prevalent
c) The schedule consists of 2 doses separated by 6 months
d) It can be given at the same time as other travel and routine vaccines
e) There is a TBE immunoglobulin available in the UK in addition to the vaccine

Answer 7

It is recommended for the protection of individuals at high risk of exposure to the virus through travel or employment

It is recommended particularly for spring and summer travel in warm, forested and endemic areas, where ticks are most prevalent

It can be given at the same time as other travel and routine vaccines

Question 8

Which of the following is/are true about tuberculosis:
a) Human tuberculosis is caused by infection with Mycobacterium tuberculosis complex
bacteria
b) Most cases in the UK are acquired by the non-respiratory route
c) Transmission is less likely when bacilli can be seen in the sputum of the index case
on microscopy
d) Patients with weakened immune systems can reactivate latent TB infection
e) In the UK, there are around 650 deaths a year either due to or associated with TB

Answer 8

Human tuberculosis is caused by infection with Mycobacterium tuberculosis complex bacteria

Patients with weakened immune systems can reactivate latent TB infection

Question 9

In the UK BCG immunisation is recommended for:

a) All school children aged 11-13 years
b) Newborns with parents from countries of high TB prevalence
c) Newborns with grandparents from countries with high TB prevalence
d) Children with asthma
e) Any adult who requests it under the age of 35

Answer 9

Newborns with parents from countries of high TB prevalence

Newborns with grandparents from countries with high TB prevalence

Question 10

Which of the following is/are true about BCG immunisation:

a) It is a live attenuated vaccine
b) It contains a strain derived from M. tuberculosis
c) Protection has been shown to last for 30-40 years
d) It is 70-80% effective against pulmonary disease
e) Unused reconstituted vaccine should be discarded after 24 hours

Answer 10

It is a live attenuated vaccine

Question 11

A tuberculin skin test prior to BCG immunisation is necessary for:
a) All individuals aged 5 years and over
b) All children under 6 years who have had a history of residence in a country with a
high TB incidence
c) A close contact of a person with TB
d) Those with any family history of TB within the last 5 years
e) A baby aged 6 weeks old who missed their neonatal BCG on the hospital ward

Answer 11

All children under 6 years who have had a history of residence in a country with a high TB incidence

A close contact of a person with TB

Those with any family history of TB within the last 5 years

Question 12

Which of the following is/are true about BCG immunisation:
a) It must be administered subcutaneously
b) It is normally given in to the lateral aspect of the arm at the level of the insertion of
the deltoid muscle
c) The correct dose for children is 0.5 ml
d) The injection should be given with the needle bevel downwards
e) A 23G short bevelled needle should be used

Answer 12

It is normally given in to the lateral aspect of the arm at the level of the insertion of the deltoid muscle

Question 13

Which of the following is/are true:
a) If BCG is administered again to an individual who has received it previously there is
a risk of an adverse reaction
b) The absence of a characteristic BCG scar is reliable evidence that BCG has not
been given previously
c) The BCG immunisation site should be covered with an occlusive dressing
d) Induration at the injection site is a usual reaction to a successful BCG immunisation
e) The enlargement of a regional lymph node to less than 1cm is a sign of an adverse
reaction

Answer 13

If BCG is administered again to an individual who has received it previously there is a risk of an adverse reaction

Induration at the injection site is a usual reaction to a successful BCG immunisation

Question 14

Which of the following is/are true about tuberculin skin testing:
a) The standard test used in the UK is the Mantoux test
b) The preparation for routine use contains 2TU/0.1 ml tuberculin PPD
c) It should normally be administered subcutaneously on the flexor surface of the left
forearm
d) The results should be read between 4-7 days later
e) It should not be carried out within 4 weeks of having received a live vaccine

Answer 14

The standard test used in the UK is the Mantoux test

The preparation for routine use contains 2TU/0.1 ml tuberculin PPD

It should not be carried out within 4 weeks of having received a live vaccine

Question 15

Which of the following is/are true about tuberculin skin testing:
a) The result of the tuberculin test can be suppressed by glandular fever
b) If a second tuberculin test is necessary, it can be administered on the same arm
c) A diameter of induration of less than 5mm is considered to be a negative Mantoux
test result
d) The results should be read 24-48 hours later
e) The area of erythema is relevant in assessing the diameter of the induration

Answer 15

The result of the tuberculin test can be suppressed by glandular fever

Question 16

Typhoid fever:
a) S. typhi and S. paratyphi also colonise animals
b) Is caused by members of the genus Salmonella
c) Has an incubation period of 1-3 weeks
d) Is transmitted via the faeco-oral route but may also be transmitted via urine in acute
and chronic cases
e) Case fatality may be as high as 20% with prompt antibiotic therapy

Answer 16

Is caused by members of the genus Salmonella

Has an incubation period of 1-3 weeks

Is transmitted via the faeco-oral route but may also be transmitted via urine in acute and chronic cases

Question 17

Typhoid is:

a) Associated with long-term carriage of the organism in 10% of cases
b) Endemic to the UK
c) Only associated with previous foreign travel in the UK
d) Predominantly a disease of foreign countries with poor sanitation
e) Endemic in resource rich countries

Answer 17

Predominantly a disease of foreign countries with poor sanitation

Question 18

Which of the following vaccines against typhoid is/are used in the UK:

a) Polysaccharide Vi vaccine
b) Whole cell typhoid vaccine
c) Oral Ty21a vaccine
d) Combined polysaccharide Vi and hepatitis A vaccine
e) All the above

Answer 18

Polysaccharide Vi vaccine

Oral Ty21a vaccine

Combined polysaccharide Vi and hepatitis A vaccine

Question 19

. Which of the following statements is/are true about typhoid polysaccharide
containing vaccines:
a) They can be given to anyone over the age of 2 years
b) A single dose is adequate to provide protection
c) Protection lasts 5 years
d) Booster doses should be given to those at continued risk of infection every 3 years
e) Children between 12 months and 2 years may be immunised if the risk of contracting
typhoid is considered to be high

Answer 19

They can be given to anyone over the age of 2 years

A single dose is adequate to provide protection

Booster doses should be given to those at continued risk of infection every 3 years

Children between 12 months and 2 years may be immunised if the risk of contracting typhoid is considered to be high

Question 20

Which of the following statements is/are true regarding Oral Ty21a vaccine:

a) It can be given to anyone over the age of 18 months
b) Has a primary schedule of 3 doses, given at 0, 2 and 4 days
c) Capsules can be taken with food
d) Protection commences about 7- 10 days after completing the primary course
e) A single booster dose should be administered to those at continuing risk of infection

Answer 20

Has a primary schedule of 3 doses, given at 0, 2 and 4 days

Protection commences about 7- 10 days after completing the primary course

Question 21

Which of the following people should be considered for typhoid vaccines:

a) Travellers to South East India
b) Travellers to Southern Switzerland
c) Travellers to South America
d) Travellers to South Asia
e) Travellers to the Middle East

Answer 21

Travellers to South East Asia

Travellers to South America

Travellers to South Asia

Travellers to the Middle East

Question 22

Which of the following should be considered for typhoid vaccines:

a) Travellers to Central America
b) Travellers to Africa
c) Laboratory staff who may handle Salmonella typhi
d) Close contacts of cases and chronic carriers
e) People exposed during an outbreak

Answer 22

Travellers to Central America

Travellers to Africa

Laboratory staff who may handle Salmonella typhi

Question 23

Which of the following should not receive polysaccharide Vi vaccines:

a) Pregnant women
b) Breast feeding mothers
c) People with a documented anaphylactic reaction to a previous dose
d) HIV positive people
e) Other people with severe immunosuppression

Answer 23

People with a documented anaphylactic reaction to a previous dose

Question 24

Adverse reactions to polysaccharide Vi vaccines include:

a) Pain at the injection site
b) Fever
c) Abdominal pain
d) Diarrhoea
e) Rash

Answer 24

Pain at the injection site

Fever

Abdominal pain

Diarrhoea

Question 25

Which of the following should not receive Oral Ty21a vaccines:

a) Those taking antibiotics
b) Those with a febrile illness
c) A person who has taken mefloquine in the last 12 hours
d) Those who are immunosuppressed
e) People with an acute gastro-intestinal illness at the time of vaccination

Answer 25

Those taking antibiotics

Those with a febrile illness

A person who has taken mefloquine in the last 12 hours

Those who are immunosuppressed

People with an acute gastro-intestinal illness at the time of vaccination

Question 26

. Adverse reactions to Oral Ty21a vaccine include:

a) Urticaria
b) Headache
c) Fever
d) Gastro-intestinal upset
e) Flu like illness

Answer 26

Headache

Fever

Gastro-intestinal upset

Flu like illness

Question 27

Which of the following statements is/are true regarding Oral Ty21a vaccine:
a) Vaccination should be delayed until 3 days after completing a course of antibiotics
b) Mefloquine can be taken at the same time as Ty21a vaccine
c) Antibiotics can be prescribed immediately after completion of a primary course
d) The fixed combination antimalarial, atovaquone and proguanil can be taken at the
same time as Ty21a
e) Other antimalarials can be taken at the same time as Ty21a

Answer 27

Vaccination should be delayed until 3 days after completing a course of antibiotics

The fixed combination antimalarial, atovaquone and proguanil can be taken at the same time as Ty21a

Question 28

Which of the following is/are true about Varicella (chickenpox):
a) It is usually acquired from other people with chickenpox
b) It may be acquired from people with shingles
c) It has a secondary infection rate of up to 90% in household contacts
d) Smoking is not a risk factor for severe disease
e) Pregnant women appear to be at greatest risk of severe disease late in the second
or early in the third trimester

Answer 28

It is usually acquired from other people with chickenpox

It may be acquired from people with shingles

It has a secondary infection rate of up to 90% in household contacts

Pregnant women appear to be at greatest risk of severe disease late in the second or early in the third trimester

Question 29

The risk to the foetus if the mother develops chickenpox in pregnancy:
a) Is 10% for congenital varicella syndrome up to 12 weeks
b) Is of herpes zoster in the second and third trimesters
c) At 7 days, before to 7 days after delivery is of severe, possibly fatal disease in the
neonate
d) Is substantially lower of congenital varicella syndrome after 20 weeks of pregnancy
e) Can be reduced by administration of varicella vaccine at any stage of pregnancy

Answer 29

Is of herpes zoster in the second and third trimesters

At 7 days, before to 7 days after delivery is of severe, possibly fatal disease in the neonate

Is substantially lower of congenital varicella syndrome after 20 weeks of pregnancy

Question 30

Varicella vaccines:
a) Are live attenuated vaccines
b) Do not contain thiomersal
c) Carry a high risk of transmission of chickenpox to close contacts of vaccinees
d) Provide 90% protection against clinical chickenpox in adults a 2-dose schedule
e) Provide 98% protection against clinical chickenpox in children with a 2-dose
schedule

Answer 30

Are live attenuated vaccines

Do not contain thiomersal

Provide 98% protection against clinical chickenpox in children with a 2-dose schedule

Question 31

Varicella zoster immunoglobulin:
a) Is prepared from pooled plasma from UK donors
b) Is limited in supply
c) Is recommended for those in a risk group with significant exposure even if they have
detectable varicella zoster antibodies
d) Is recommended for at risk persons in contact with immunocompetent individuals
with ophthalmic shingles
e) Is recommended for at risk persons exposed up to 5 days before the appearance of
the chickenpox rash

Answer 31

Is limited in supply

Is recommended for at risk persons in contact with immunocompetent individuals with ophthalmic shingles

Question 32

Which of the following is/are included in the definition of a significant exposure to
varicella zoster virus:
a) Exposure to chickenpox
b) Exposure to immunosuppressed patients with localised zoster
c) Exposure up to 72 hours before the onset of a chickenpox rash
d) Exposure on the day of occurrence of shingles affecting the eye
e) Contact in the same room for 2 minutes

Answer 32

Exposure to chickenpox

Exposure to immunosuppressed patients with localised zoster

Exposure on the day of occurrence of shingles affecting the eye

Question 33

In neonates VZIG is recommended for:
a) Those whose mothers develop chickenpox the day after delivery
b) Those whose mothers develop chickenpox 10 days before delivery
c) Infants whose mothers do not have VZ antibodies and are exposed to a sibling with
chickenpox at 1 month of age
d) VZ antibody negative infants born at 27 weeks in neonatal intensive who are
exposed to a healthcare worker with chickenpox
e) VZ antibody negative infants 70 days old in neonatal intensive exposed to a
healthcare worker with chickenpox

Answer 33

Those whose mothers develop chickenpox the day after delivery

VZ antibody negative infants born at 27 weeks in neonatal intensive who are exposed to a healthcare worker with chickenpox

VZ antibody negative infants 70 days old in neonatal intensive exposed to a healthcare worker with chickenpox

Question 34

Which of the following is/are true about Varicella Zoster Immune Globulin (VZIG)
prophylaxis:
a) It always prevents severe chickenpox
b) It can significantly increase VZ antibody titres in immunocompromised contacts who
are already antibody positive
c) It may not prevent subclinical disease
d) It always prevents congenital varicella
e) Patients given it should be offered aciclovir if chickenpox develops

Answer 34

May not prevent subclinical disease

Patients given it should be offered aciclovir if chickenpox develops

Question 35

Varicella vaccine should not be given to:

a) Immunosuppressed patients
b) Pregnant women
c) Those with a confirmed anaphylactic reaction to neomycin or gelatine
d) Women who are breast feeding
e) Non-immune contacts within 3 days of exposure

Answer 35

Immunosuppressed patients

Pregnant women

Those with a confirmed anaphylactic reaction to neomycin or gelatine

Question 36

Which of the following is/are true about Yellow fever vaccine:
a) It is a live attenuated vaccine containing live strain (17D) of the virus
b) It can be given at any time relationship to other live and inactivated vaccines
although an interval of 28 days is recommended in the case of MMR vaccine
c) A single dose confers immunity in 95–100% of recipients (if administered correctly)
d) Immunity persists for no more than 5 years
e) The risk of neurological and viscerotropic adverse events decreases with age

Answer 36

It is a live attenuated vaccine containing live strain (17D) of the virus

It can be given at any time relationship to other live and inactivated vaccines although an interval of 28 days is recommended in the case of MMR vaccine

A single dose confers immunity in 95–100% of recipients (if administered correctly)

Question 37

Yellow fever vaccine should be given:
a) At least 5 days prior to travel to an endemic area
b) To laboratory workers handling infected materials
c) To persons who are travelling to countries that require International Certificate of
Vaccination or Prophylaxis(ICVP) for entry
d) To persons who are travelling to an endemic area even if the country does not
require a certificate
e) As a single dose with a booster dose at 6 months

Answer 37

To laboratory workers handling infected materials

To persons who are travelling to countries that require International Certificate of Vaccination or Prophylaxis(ICVP) for entry

To persons who are travelling to an endemic area even if the country does not require a certificate

Question 38

Which of the following is/are true? Yellow fever vaccine should not be given to
those:
a) Over 60 years of age
b) Under 6 months of age
c) Who have a history of thymus disorder or thymectomy
d) Who have had a confirmed anaphylactic reaction to a previous dose, any
components of the vaccine and egg
e) Who are considered immunocompromised due to a congenital condition disease
process

Answer 38

Under 6 months of age

Who have a history of thymus disorder or thymectomy

Who have had a confirmed anaphylactic reaction to a previous dose, any components of the vaccine and egg

Who are considered immunocompromised due to a congenital condition disease process