Vaccines Flashcards
A 68-year-old female presents for an annual health maintenance visit. She says that she does not receive the influenza vaccine because she developed hives many years ago after eating eggs.
Which one of the following would you recommend? (check one)
Avoiding influenza vaccine
Proceeding with in-office vaccination without premedication
Diphenhydramine (Benadryl Allergy), 50 mg 4 hours prior to vaccination
Prednisone, 20 mg 4 hours prior to vaccination
Referral to an allergist for desensitization
Proceeding with in-office vaccination without premedication
It is uncommon for people to experience severe reactions, including anaphylaxis, after influenza vaccination. This is true even for those with egg allergies, despite the fact that embryonic chicken eggs are used to grow most influenza vaccine viruses. Influenza vaccine is safe to administer regularly to those who have only had hives after exposure to eggs. If more serious allergic symptoms occur with egg exposure, such as respiratory distress or anaphylaxis, influenza vaccine should be administered in an inpatient or supervised outpatient setting. Premedication with diphenhydramine or prednisone is not recommended. Referral to an allergist for desensitization would not be recommended for this patient.
A 66-year-old female with a past medical history of well-controlled type 2 diabetes diagnosed at age 60 presents for a health maintenance examination. She was previously vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23) at the time of her diabetes diagnosis.
Based on CDC guidelines, which one of the following should you recommend to her today to complete her pneumococcal vaccination series? (check one)
No additional pneumococcal vaccine
A repeat dose of PPSV23
13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13)
15-valent pneumococcal conjugate vaccine (PCV15, Vaxneuvance)
20-valent pneumococcal conjugate vaccine (PCV20, Prevnar 20)
20-valent pneumococcal conjugate vaccine (PCV20, Prevnar 20)
In patients who were previously vaccinated with 23-valent pneumococcal polysaccharide vaccine between the ages of 19 and 64 due to risk factors such as type 2 diabetes, the CDC now recommends one dose of 20-valent pneumococcal conjugate vaccine.
A large wooden splinter went deep into the forearm of a 24-year-old male while he was working in a horse barn, and he has required local anesthesia and a small incision to remove it completely. After thorough wound cleansing, you inquire about his tetanus status. He is certain that he received all of his primary childhood vaccines and a “tetanus booster” at age 20, but does not know which vaccine he received.
Which one of the following is the best choice for this patient regarding tetanus immunization at this time? (check one)
TT (tetanus toxoid)
Td (tetanus toxoid with reduced diphtheria
Tdap (tetanus toxoid with reduced diphtheria and acellular pertussis)
TIG (tetanus immune globulin
No immunization
No immunization
The Advisory Committee on Immunization Practices (ACIP) periodically makes recommendations for routine or postexposure immunization for a number of preventable diseases, including tetanus. Since 2005, the recommendation for tetanus prophylaxis has included coverage not only for diphtheria (Td) but also pertussis, due to waning immunity in the general population. The current recommendation for adults who require a tetanus booster (either as a routine vaccination or as part of treatment for a wound) is to use the pertussis-containing Tdap unless it has been less than 5 years since the last booster in someone who has completed the primary vaccination series.
In this scenario, no additional vaccination is needed at this time, since the patient is certain of completing the primary vaccinations and received a tetanus booster within the previous 5 years. Had the interval been longer than 5 years, then a single dose of Tdap would be appropriate unless his previous booster was Tdap. Tetanus immune globulin is recommended in addition to tetanus vaccine for wounds that are tetanus-prone due to contamination and tissue damage in persons with an uncertain primary vaccine history. Plain tetanus toxoid (TT) is usually indicated only when the diphtheria component is contraindicated, which is uncommon.
Routine vaccination against which one of the following organisms has significantly reduced the risk of bacterial meningitis among young children? (check one)
Borrelia burgdorferi
Escherichia coli
Haemophilus influenzae
Listeria monocytogenes
Mycoplasma pneumoniae
Haemophilus influenzae
Conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae have been highly effective in reducing the incidence of bacterial meningitis in young children and are now routinely recommended for infants and older patients who fall into appropriate risk groups (SOR B). Escherichia coli and Listeria monocytogenes also cause meningitis in young children, but there is not currently a routine vaccine for these pathogens. Likewise, Borrelia burgdorferi and Mycoplasma pneumoniae can cause aseptic meningitis, but there is no routine vaccine.
A 52-year-old white male presents for a health maintenance visit. The patient has mild osteoarthritis but is otherwise healthy. He lives at home with his wife. He drinks approximately 2 beers a week and does not smoke. He takes a multivitamin, but no other medications.
What is the recommendation for immunizing this patient with pneumococcal polyvalent-23 vaccine (Pneumovax)? (check one)
One dose now
One dose after age 65
One dose now, and again after age 65
One dose now, in 5 years, and again after age 65
No vaccination unless he develops an immunocompromising disease
One dose after age 65
For a healthy nonsmoker with no chronic disease who is not in a high-risk group, pneumococcal vaccine is recommended once at age 65, or as soon afterward as possible. Persons that should be immunized before age 65 include patients with chronic lung disease, cardiovascular disease, diabetes mellitus, chronic liver disease, cerebrospinal fluid leaks, cochlear implants, immunocompromising conditions, or asplenia, and residents of nursing homes and long-term care facilities. The Advisory Committee on Immunization Practices of the CDC updated the recommendations for pneumococcal vaccination in 2011 to include immunization for persons age 50–64 in the following categories: Alaska Natives, Native Americans living in areas of increased risk, persons with asthma, and smokers.
A 21-year-old primigravida at 10 weeks gestation has a negative titer for rubella.
The best procedure to follow is to?
(check one)
Institute a (-globulin regimen and maintain it throughout her pregnancy
Administer rubella vaccine after 12 weeks gestation
Administer rubella vaccine immediately post partum
Administer rubella vaccine 12 weeks post partum
Administer rubella vaccine immediately post partum
Rubella has been directly responsible for inestimable pregnancy wastage, as well as for severe congenital malformations. Identification and vaccination of unimmunized women immediately after childbirth or abortion is recommended. The use of (-globulin to prevent viremia in nonimmune subjects exposed to rubella is not recommended. The vaccine should be avoided shortly before or during pregnancy since it is an attenuated live virus. Because of herd immunity there is a very low likelihood that this patient will be exposed to rubella.
Which one of the following is a contraindication to immunization with MMR? (check one)
The patient had a tuberculosis skin test (PPD) within the previous 2 days
A household member of the patient has an immunodeficiency
The mother of the patient is pregnant
The patient is pregnant
The patient is breastfeeding her newborn infant
The patient is pregnant
The failure to provide immunizations because of perceived contraindications is one of the most common reasons for an inadequately protected population. A PPD may be falsely negative if administered 2-30 days after MMR administration, not the reverse. If the patient is immunodeficient or pregnant, rather than a household contact, then MMR is contraindicated. Breastfeeding is not a contraindication.
Which one of the following vaccines is CONTRAINDICATED during pregnancy? (check one)
Hepatitis A
Hepatitis B
Rabies
Tdap
Varicella
Varicella
The varicella vaccine is a live virus vaccine that is contraindicated during pregnancy because of the potential for fetal infection. The indications for hepatitis A, hepatitis B, rabies, and Tdap vaccines are the same for pregnant patients and nonpregnant patients.
A 45-year-old male with diabetes mellitus sees you for the first time. If the patient has not
previously received it, which one of the following vaccines is recommended for him by the
Advisory Committee on Immunization Practices?
(check one)
Hepatitis A
Hepatitis B
Meningococcal
Varicella zoster
Hepatitis B
Late in 2012, the Advisory Committee on Immunization Practices of the Centers for Disease Control and
Prevention recommended hepatitis B vaccine for all previously unvaccinated adults between the ages of
19 and 59 with diabetes mellitus, as soon as possible after the diagnosis of diabetes is made. Vaccination
should be considered for patients ³ age 60, after assessing their risk and the likelihood of an adequate
immune response.
A 33-year-old gravida 3 para 2 presents for prenatal care 8 weeks after her last menstrual period. She asks if she will need any immunizations during this pregnancy.
Which one of the following vaccines is recommended for all women with each pregnancy? (check one)
13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13)
Hepatitis B
MMR
Tdap
Varicella
Tdap
Tdap is recommended for all women with each pregnancy, preferably between 27 and 36 weeks gestation. Live vaccines such as varicella and MMR are contraindicated during pregnancy. There is inadequate data to recommend vaccination against pneumococcal disease during pregnancy. Hepatitis B vaccine is recommended during pregnancy only for women at high risk for infection.
A patient asks which shingles vaccine he should receive. Which one of the following is an advantage of the recombinant zoster vaccine (Shingrix) compared to the live zoster vaccine (Zostavax)? (check one)
Improved efficacy
Lower cost
Subcutaneous administration
Proven safety for immunocompromised patients
Administration as a single dose
Improved efficacy
The recombinant zoster vaccine is preferred over the live zoster vaccine due to its increased efficacy. The recombinant vaccine is estimated to be about 97% effective for preventing shingles, compared to 51% with the live vaccine. It requires two intramuscular doses separated by 2–6 months, compared to only one subcutaneous dose with the live vaccine. It is also slightly more expensive than the live vaccine. Although the recombinant vaccine is not a live vaccine, studies are still ongoing as to whether it is safe to give to immunocompromised patients.
A healthy 2-month-old female is brought to your office for a routine well baby examination by both of her parents, who have no concerns. The parents refuse routine recommended vaccines for their daughter because of their personal beliefs.
You want to incorporate patient-centeredness and are also concerned about improving the health of the population. You decide to follow the CDC recommendations by (check one)
accepting their decision without further action
not offering vaccines at future visits to preserve a positive doctor-patient relationship
having the parents sign a refusal to vaccinate form
dismissing the family from the practice
pursuing a court order for vaccine administration since the child has no medical exemptions
having the parents sign a refusal to vaccinate form
Experts recommend that a refusal to vaccinate form be signed by patients or parents who refuse a recommended vaccine. This form should document that the patient/parents were provided the vaccine information statement (SOR C). The CDC recommends against dismissing a patient or family from a practice if they refuse vaccination. Physicians should continue to discuss the benefits of immunizations at subsequent visits, because some patients/parents may reconsider their decision not to vaccinate.
A 4-month-old female is brought to your clinic for a routine well child visit. She has not been seen by a physician since 2 weeks of age due to parental concerns about seeking care during the COVID-19 pandemic. Her growth and development appear to be normal.
Which one of the following vaccines is CONTRAINDICATED today? (check one)
Haemophilus influenzae type b
Hepatitis B
Inactivated poliovirus
13-valent pneumococcal conjugate (PCV13, Prevnar 13)
Rotavirus
Rotavirus
Vaccine delay and vaccine hesitancy are on the rise in the United States, so family physicians should be familiar with the nuances of vaccine catch-up schedules as well as contraindications. Rotavirus vaccine has age restrictions and should not be initiated after 14 weeks and 6 days of age. In addition, the rotavirus series must be complete by 8 months of age. These age restrictions are intended to ensure the vaccine is administered when it will be of maximal benefit to children given the slightly increased risk of intussusception after vaccine administration. Hepatitis B vaccine should be administered at routine intervals. Haemophilus influenzae type b, inactivated poliovirus, and pneumococcal conjugate can all be administered to this patient today. However, these vaccines have complex follow-up intervals based on the age at prior doses and age at catch-up. Therefore, the clinician should consult the CDC catch-up vaccine schedule to verify dosing intervals.
You see a 12-year-old female for a well child check. She is healthy without any medical problems and neither she nor her father have any concerns today. She is up to date on her immunizations except for her third dose of HPV vaccine. She received the first dose of the vaccine at her 11-year-old well child check and her second dose 1 month later. However, she was told by a few friends that they only needed to get two doses of HPV vaccine, so she is very excited that she does not need any shots today.
According to the CDC, which one of the following is true regarding HPV vaccine for this patient? (check one)
She has completed her HPV vaccine series
She should receive a third dose of HPV vaccine today
She needs an HPV booster at age 21 but does not need a third dose of vaccine today
She should have HPV titers drawn today and receive a third dose of vaccine only if the titers are low
She should receive a third dose of HPV vaccine today
In 2016 the CDC changed the recommendation for the number of HPV vaccine doses for children ages 11–14. Children in this age group need only two doses of HPV vaccine 6–12 months apart. However, if they received two doses of HPV vaccine less than 5 months apart, they still need to have the third dose. Children and young adults over the age of 14 and those with certain immunocompromising conditions still require three doses of HPV vaccine. There is no indication for a booster dose at a later date, nor is there clinical data to support using titers to gauge immunogenicity to HPV.
A 62-year-old male sees you for a routine health maintenance examination, and you note that he has not yet received the recombinant zoster vaccine (Shingrix). Which one of the following approaches is most likely to result in your patient accepting this immunization? (check one)
“Are there any immunizations you would like today?”
“You have been a bit negligent on obtaining your shingles vaccine. May we give that to you?”
“You have not yet received your shingles vaccine. May we give that to you before you leave?”
“You have not yet received your shingles vaccine. We are preparing to administer that today. Do you have any questions?”
“You have not yet received your shingles vaccine. We are preparing to administer that today. Do you have any questions?”
Employing a presumptive approach rather than a participatory approach significantly increases the likelihood that a patient, parent, or guardian will accept a recommended vaccine. This strategy implies that accepting the immunization is the usual or normal choice. The correct option in this scenario presumes the patient will accept the immunization, while the remainder of the options ask if they will.
