Vaccines Flashcards
1
Q
- When considering a person’s risk for measles, mumps,
and rubella, the NP considers the following:
A. Children should have two doses of the measles,
mumps, and rubella (MMR) vaccine before their
sixth birthday.
B. Considerable mortality and morbidity occur with all
three diseases.
C. Most cases of the three diseases in the United States
occur in infants.
D. The use of the vaccine is often associated with
protracted arthralgia.
A
A
2
Q
- Which of the following is true about the MMR vaccine?
A. This vaccine contains live virus.
B. Its use is contraindicated in persons with a history of
egg allergy.
C. Revaccination of an immune person is associated
with risk of allergic reaction.
D. One dose is recommended for young adults who
have not been previously immunized.
A
A
3
Q
- How many doses of the MMR vaccine should a child
6 to 11 months of age receive before traveling outside
of the United States?
A. none
B. one dose
C. two doses
D. depends on where the child is traveling
A
B
4
Q
- A 9-year-old child with no documentation of vaccinations
comes in for an MMR immunization update.
Her parent states that child has received “some”
vaccinations, but no documentation is available. How
many doses of MMR should the child receive and at
what frequency?
A. one MMR dose
B. two MMR doses together at the same time
C. two MMR doses 1 month apart
D. no MMR immunization is needed
A
C
5
Q
62. Which of the following viruses is a potent teratogen? A. measles B. mumps C. rubella D. influenza
A
C
6
Q
- Evidence demonstrates that the MMR virus
acquired via vaccine can be shed into the body
during lactation.
A. true
B. false
A
B
7
Q
- In whom is serological documentation of immunity to
rubella advised?
A. school-aged children
B. government employees
C. pregnant women and women of childbearing age
who could become pregnant
D. members of the armed forces
A
C
8
Q
- When advising parents about injectable inactivated
influenza vaccine, trivalent or quadrivalent (IIV 3 or
IIV4), the clinician considers the following about the
vaccine:
A. The vaccine is contraindicated with a personal
history of a mild hive-form reaction to eggs.
B. Its use is limited to children older than 2 years.
C. The vaccine contains live virus.
D. Its use is recommended for members of households
containing high-risk patients.
A
D
9
Q
- A 7-year-old child with type 1 diabetes mellitus is
about to receive injectable inactivated influenza
vaccine, trivalent (IIV3). His parents and he should
be advised that:
A. the vaccine is more than 90% effective in preventing
influenza.
B. use of the vaccine is contraindicated during antibiotic
therapy.
C. localized immunization reactions are common.
D. a short, intense, flu-like syndrome typically occurs
after immunization.
A
C
10
Q
- When giving IIV3 or IIV4 to a 7-year-old who has not
received any influenza immunization in the past, the
NP considers that:
A. two doses 4 weeks or more apart should be given.
B. a single dose is adequate.
C. children in this age group have the highest rate of
influenza-related hospitalization.
D. the vaccine should not be given to a child with
shellfish allergy
A
A
11
Q
- With regard to seasonal influenza prevention in well
children, the NP considers that:
A. compared with school-aged children, younger
children (≤24 months old) have an increased risk
of seasonal influenza-related hospitalization.
B. a full adult dose of seasonal influenza vaccine should
be given starting at age 4 years.
C. the use of the seasonal influenza vaccine in well
children is discouraged.
D. widespread use of the vaccine is likely to increase
the risk of eczema and antibiotic allergies.
A
A
12
Q
- When advising a patient about immunization with the
nasal spray live attenuated influenza vaccine (LAIV,
Flumist®), the NP considers the following:
A. Its use is acceptable during pregnancy.
B. Its use is limited to children younger than age 2 years.
C. Its use is currently not recommended owing to low
effectiveness.
D. A potentially harmful virus can be shed to vulnerable
household members postvaccination.
A
C
13
Q
- Which of the following should not receive vaccination
against influenza?
A. a 19-year-old with a history of hive-form reaction to
eating eggs
B. a 24-year-old woman who is 8 weeks pregnant
C. a 4-month-old infant who was born at 32 weeks’
gestation
D. a 28-year-old woman who is breastfeeding a 2-weekold
infant
A
C
14
Q
71. The most common mode of influenza virus transmission is via: A. contact with a contaminated surface. B. respiratory droplet. C. saliva contact. D. skin-to-skin contact.
A
B
15
Q
- Which of the following is at greatest risk of having serious
flu-related complications?
A. a 7-year-old with a recent previous episode of acute
otitis media
B. a 4-year-old with asthma
C. a 9-year-old living with a grandparent with chronic
obstructive pulmonary disease (COPD)
D. a 6-year-old entering his first year of public school
A
B
16
Q
- When considering vaccinating a pregnant woman with
IIV3 or IIV4, the NP considers that:
A. there is a small risk of the virus spreading to the
fetus.
B. immunization should not be done in the third
trimester.
C. the unborn child acquires some protection against
influenza up to 6 months after birth.
D. LAIV is the preferred vaccine for pregnant women.
A
C
17
Q
All children aged 6 months to 8 years who receive a seasonal influenza vaccine for the first time
A
should receive two doses.
18
Q
Children who received only one dose of a seasonal influenza vaccine in the first influenza season
A
should receive two
doses, rather than one, the following influenza season
19
Q
High risk of serious flu-related complications
A
• Women who are or will be pregnant during the influenza season
20
Q
High risk of serious flu-related complications
A
• All children aged 6 through 59 months
21
Q
High risk of serious flu-related complications
A
• Individuals age 50 years of age and older
22
Q
High risk of serious flu-related complications
A
• Individuals of any age with certain chronic medical conditions or who have immunosuppression
23
Q
High risk of serious flu-related complications
A
• Residents of nursing homes and other long-term care facilities
24
Q
High risk of serious flu-related complications
A
• Persons who are extremely obese (BMI ≥40 kg/m2)
25
High risk of serious flu-related complications
• People who live with or care for those at high risk for complications from flu, including:
• Healthcare workers
• Household contacts of persons at high risk for complications from the flu
• Household contacts and out-of-home caregivers of children younger than 6 months of age (these children are too
young to be vaccinated)
26
Until relatively recently, egg allergy was considered a
contraindication to receiving all forms of influenza vaccine.
Current recommendations advise that most individuals
with an egg allergy
can safely receive the influenza vaccine
27
Recombinant influenza vaccine (RIV; FluBlok®)
egg-free vaccine preparation that can be considered
| for patients with a history of severe allergic reaction to eggs.
28
74. Which of the following statements is true about the
hepatitis B virus (HBV) vaccine?
A. The vaccine contains live HBV.
B. Children should have hepatitis B surface antibody
(HBsAb, anti-HBs) titers drawn one month
following completion of the HBV series.
C. Hepatitis B immunization series should be
offered to all children.
D. Serological testing for HBsAb should be
checked before HBV vaccination is initiated
in children.
C
29
75. You are making rounds in the nursery and examine the
neonate of a mother who is HBsAg-positive. Your most
appropriate action is to:
A. administer hepatitis B immune globulin (HBIG) to
the neonate.
B. isolate the infant.
C. administer hepatitis B immunization to the mother.
D. give hepatitis B immunization and HBIG to the
neonate.
D
30
76. Without intervention, approximately 40% of infants
born to mothers with acute or chronic HBV infection
will go on to:
A. develop acute hepatitis B infection.
B. die of chronic liver disease.
C. develop chronic hepatitis B.
D. develop lifelong immunity to the hepatitis B virus.
C
31
77. Hepatitis B vaccine should not be given to a person
with a history of anaphylactic reaction to:
A. egg.
B. baker’s yeast.
C. neomycin.
D. streptomycin.
B
32
78. Infants who have been infected perinatally with HBV
have an estimated % lifetime chance of developing
hepatocellular carcinoma or cirrhosis.
A. 10
B. 25
C. 50
D. 75
B
33
79. Terrance is a 15-year-old male who has not received
any dose of the HBV vaccine. When considering
whether to initiate the vaccine series, the NP realizes:
A. at his age, Terrance has likely already been exposed
to HBV and does not need vaccination.
B. risk of HBV is extremely low after age 10 years and
vaccination is not needed.
C. vaccination can help prevent sexual transmission
of HBV.
D. vaccination at his age is not as effective compared
with completing the vaccine series at an earlier age.
B
34
80. Jason is a healthy 18-year-old who presents for primary
care. According to his immunization record, he received
one dose of the recommended HBV vaccine series at
age 14. Which of the following best describes his HBV
vaccination needs?
A. He should complete the recommended HBV vaccine
series.
B. Because there is a gap in his vaccination, the HBV
vaccine series needs to be restarted.
C. Given that he was a teen when he received his HBV
vaccine, a single dose is sufficient.
D. He should be tested for HBsAb and further
immunization recommendations should be
made according to the test results.
A
35
```
81. Universal infant vaccination against HBV was recommended
in what year?
A. 1972
B. 1978
C. 1982
D. 1991
```
D
36
```
82. Routine adolescent vaccination against HBV was
recommended in what year?
A. 1996
B. 1991
C. 1982
D. 1978
```
A
37
83. Testing for HBsAg is most appropriate for which of the
following?
A. an 8-month-old infant born at 34 weeks’ gestation
and who just completed the 3-dose vaccine series
B. a 14-year-old who completed the 2-dose HBV
vaccine regimen
C. a 5-year-old who was recently adopted from another
state
D. a 3-year-old who was recently adopted from another
country
D
38
HBV vaccine is recommended routinely for all infants
| and is administered in
three-injection series at 0, 1, and
| 6 months of age.
39
The MMR vaccine
is a live, attenuated vaccine
40
MMR vaccine: The recommended
| schedule for early childhood immunization
is two doses of MMR vaccine, one given between ages 12 and 15 months and one between 4 and 6 years
41
Infants traveling abroad
The CDC recommends giving one dose of MMR
| to infants 6 through 11 months of age if traveling outside of the United States
42
MMR vaccine: older children
| who were not immunized earlier in life
Two immunizations 1 month apart are recommended
43
Rubella
potent teratogen - causes congenital rubella syndrome
44
MMR vaccine: contraindicated when?
pregnancy - may pass to unborn child
45
Verify immunity to measles, mumps, or rubella
documentation of vaccination, laboratory
| evidence of disease, birth date before 1957, or laboratory evidence of immune markers
46
2-dose HBV vaccine
approved by the U.S. Food and Drug Administration
| (FDA) for adolescents and adults
47
HBV vaccine series is intrurrupted after first dose
second dose should be administered as soon as possible
48
HBV vaccine series is intrurrupted after first dose
second and third doses should be separated by 8 week interval (second dose can be given as soon as possible).
49
2-dose HBV vaccine
the adult
dose of recombinant HBV vaccine is administered to 11- to
15-year-olds with the second dose given 4 to 6 months later
50
Infants who have been infected perinatally with
| HBV
have an estimated 25% lifetime chance of developing
| hepatocellular carcinoma or cirrhosis
51
During the first 24 hours of life, a neonate born to a
| mother with HBV
```
should receive HBV vaccine and hepatitis B
immune globulin (HBIG) to minimize the risk of perinatal transmission
```
52
If maternal HBsAg status is unknown
consideration should be given to testing the child for evidence of perinatal acquisition of HBV infection
53
Without intervention, the risk for chronic HBV infection
is 70% to 90% by age 6 months in a newborn infant whose mother is positive for both HBsAg and HBeAg
54
Without intervention, the risk for chronic HBV infection
<10% for
| infants of women who are HBsAg positive but HBeAg negative.
55
HBV vaccine and one dose of HBIG administered within 24 hours after birth
85% to 95% effective in preventing
| both acute HBV infection and chronic infection
56
84. Which of the following statements is correct about the varicella vaccine?
A. This vaccine contains killed varicella-zoster
virus (VZV).
B. A short febrile illness is common during the first
days after vaccination.
C. Children should have a varicella titer drawn before
receiving the vaccine.
D. Rarely, mild cases of chickenpox (varicella) have
been reported in immunized patients.
D
57
```
85. Expected outcomes with the use of varicella vaccine include a reduction in the rate of all of the following except:
A. shingles.
B. Reye’s syndrome.
C. aspirin sensitivity.
D. invasive varicella.
```
C
58
86. A parent asks about varicella-zoster immune globulin, and you reply that it is a:
A. synthetic product that is well tolerated.
B. derived blood product that has been known to
transmit infectious disease.
C. blood product obtained from a single donor.
D. pooled blood product with an excellent safety profile.
D
59
```
87. A healthy 5-year-old child who has not received varicella vaccine nor had the disease is exposed to chickenpox at school. How soon after exposure will a dose of the varicella vaccine prevent or modify the disease in the child?
A. only if given the same day
B. only if given within 2 to 3 days
C. if given within 3 to 5 days
D. if given within 1 week
```
C
60
88. Maria is a 28-year-old well woman who is 6 weeks pregnant and voices her intent to breastfeed her infant for at least 6 months. Her routine prenatal laboratory testing reveals she is not immune to varicella. Which of the following represents the best advice for Maria?
A. She should receive VZV vaccine once she is in her
second pregnancy trimester.
B. Maria should be advised to receive two appropriately
timed doses of VZV vaccine after giving birth.
C. Once Maria is no longer breastfeeding, she should
receive one dose of VZV vaccine.
D. A dose of VZIG should be administered now.
B
61
```
89. How is the varicella virus most commonly transmitted?
A. droplet transmission
B. contact with inanimate reservoirs
C. contact transmission
D. waterborne transmission
```
A
62
90. Which groups with no history of varicella infection or previous immunization should be targeted for vaccination? (Choose all that apply.)
A. those born before 1980
B. individuals >8 years old with HIV infection with
CD4+ T-lymphocyte counts ≥200 cells/μL
C. adults and children with a history of anaphylactic
reaction when exposed to neomycin
D. day-care workers
B,D
63
```
91. Which group is shown to have the highest rate of
serious varicella disease?
A. infants
B. teenagers aged 12–19
C. adults aged 30–49
D. health-care workers
```
A
64
92. Potential complications of varicella infection in
children include all of the following except:
A. pneumonia.
B. Crohn’s disease.
C. encephalitis.
D. toxic shock syndrome.
B
65
```
93. At what time during pregnancy is the fetus at greatest risk of developing birth defects due to congenital varicella syndrome?
A. 8–20 weeks’ gestation
B. 20–24 weeks’ gestation
C. 26–32 weeks’ gestation
D. at any time after 34 weeks’ gestation
```
A
66
About 15% of people who have had
| chickenpox
develop shingles at least once during their lifetime
67
Varicella virus transmission is
transmitted via respiratory droplet and contact with open lesions
68
Chickenpox can be serious in:
infants or immunocompromised
69
Complications of varicella
bacterial infection of skin lesions, pneumonia, encephalitis, toxic shock syndrome, and Reye’s syndrome (for those taking aspirin during infection).
70
Varicella: measurement of immunity
- patient reported history
- serological evidence of immunity
- individuals born before 1980
71
Who should have varicella serological testing to show immunity?
pregnant women and immunocompromised
72
Varicella titers should be done for?
healthcare workers
73
Varicella vaccine contains?
live attenuated virus
74
Varicella vaccine is administered
in two doses, one at age 1 year and the second at age 4 to 6 years
75
Older children and adults with no history of varicella infection or previous immunization
should receive two immunizations 4 to 8 weeks
| apart
76
healthcare workers, people >8 years old
with HIV and CD4+ T-lymphocyte counts ≥200 cells/μL, family contacts of immunocompromised patients, and day-care workers without evidence of varicella immunity
Should be targeted for varicella vaccine
77
mild forms of chickenpox
are occasionally reported after immunization
78
Pregnant women and varicella
Women who do not have evidence of immunity should receive:
The first dose of varicella vaccine on completion or termination of pregnancy and before
discharge from the healthcare facility.
The second dose should be administered 4 to 8 weeks after the first dose
79
varicella infection occurs during the first 20 weeks of pregnancy (particularly between 8 and 20 weeks)
the fetus is at risk of developing
congenital varicella syndrome, which can cause skin scarring, underdeveloped limbs, eye inflammation, and incomplete brain development
80
Infection occurring within days of delivery
neonatal varicella, which is potentially
| life-threatening
81
vaccination within 3 to 5 days of exposure to
varicella is beneficial in preventing or modifying the disease
82
94. An 11-year-old well child presents with no documented primary tetanus immunization series.
Which of the following represents the immunization
needed?
A. three doses of DTaP (diphtheria, tetanus, acellular
pertussis) vaccine 2 months apart
B. tetanus immune globulin now and two doses of
tetanus-diphtheria (Td) 1 month apart
C. one dose of Tdap (tetanus, diphtheria, acellular
pertussis vaccine) followed by two doses of Td
(tetanus, diphtheria) in 1 and 6 months
D. Td (tetanus, diphtheria) as a single dose
C
83
95. Problems after tetanus immunization typically
include:
A. localized reaction at site of injection.
B. myalgia and malaise.
C. low-grade fever.
D. diffuse rash.
A
84
96. Which wound presents the greatest risk for tetanus
infection?
A. a puncture wound obtained while playing in a
garden
B. a laceration obtained from a knife used to trim
raw beef
C. a human bite
D. an abrasion obtained by falling on a sidewalk
A
85
```
97. Infection with Corynebacterium diphtheriae usually
causes:
A. a diffuse rash.
B. meningitis.
C. pseudomembranous pharyngitis.
D. a gastroenteritis-like illness.
```
C
86
```
98. Pertussis is primarily spread via:
A. contact with a contaminated surface.
B. respiratory droplet.
C. blood contact.
D. skin-to-skin contact.
```
B
87
```
99. At which age is a child at greatest risk of death from pertussis?
A. <1 year
B. 2–4 years
C. 5–10 years
D. >10 years
```
A
88
100. Common signs and symptoms of pertussis in a
3-year-old child include all of the following except:
A. uncontrollable cough.
B. vomiting.
C. fatigue.
D. diffuse rash.
D
89
101. The most helpful tests to support the diagnosis of
pertussis include which of the following? (More than
one can apply.)
A. chest x-ray
B. nasopharyngeal culture
C. blood culture
D. polymerase chain reaction (PCR) testing
B,D
90
102. Which of the following can be used to differentiate
pertussis from acute bronchitis or asthma exacerbation?
A. presence of fever
B. PCR assay
C. presence of productive cough
D. evidence of consolidation on chest x-ray
B
91
```
103. The preferred treatment option for a 6-year-old boy with demonstrated pertussis is:
A. amoxicillin.
B. ceftriaxone.
C. azithromycin.
D. levofloxacin.
```
C
92
104. Susan is in her second trimester of pregnancy. Her
records show that she last received the Tdap vaccine
2 years ago during her last pregnancy. The NP
recommends:
A. a Tdap vaccination during the third trimester.
B. a Tdap vaccination soon after delivery.
C. a Td booster immediately.
D. a Td booster in 8 years.
A
93
105. To ensure a newborn is protected from pertussis,
is it important that the Tdap immunization status
is up-to-date for:
A. all children in the household <10 years of age.
B. the mother and all children in the household
<5 years of age.
C. any immunocompromised household members.
D. all members of the household and anyone who will
be in close contact with the newborn.
D
94
106. For a 3-year-old who is up-to-date with recommended
immunizations and was exposed to pertussis, postexposure
prophylaxis can include treatment with:
A. a beta-lactam.
B. a macrolide.
C. a systemic antifungal.
D. an additional dose of DTaP.
B
95
```
107. The incubation period for pertussis is up to:
A. 3 days.
B. 10 days.
C. 3 weeks.
D. 3 months.
```
C
96
```
108. One year after completing the 5-dose series of DTaP, approximately of children are protected against
pertussis.
A. 45%
B. 67%
C. 80%
D. 98%
```
D
97
109. Effective herd immunity against pertussis requires
of the population being up-to-date on pertussis
immunization.
A. 30%
B. 50%
C. 75%
D. >90%
D
98
Clostridium tetani
The tetanus infection is caused by Clostridium tetani, an anaerobic, gram-positive, spore-forming rod. This organism is found in soil and is particularly potent in manure
99
Tetanus
enters the body through a contaminated wound
| and causes a life-threatening systemic disease characterized by painful muscle weakness and spasm (“lockjaw”).
100
Diphtheria
Diphtheria is caused by C. diphtheriae, a gram-negative bacillus. This infection is typically transmitted person-to-person or through contaminated liquids such as milk
101
Diphtheria is characterized by
severe respiratory tract infection, including
| the appearance of pseudomembranous pharyngitis
102
Pertussis, or whopping cough
is a highly contagious disease that is passed from person to person by droplets from coughing or sneezing.
103
Pertussis
Symptoms of pertussis usually develop within 7 to 10 days after being exposed, but they may appear up to 6 weeks later
104
Pertussis causes
```
paroxysmal cough (a series of severe, vigorous
coughs during a single expiration) that often makes it difficult to breathe. Following a coughing fit, the child often needs to take deep breaths resulting in the high-pitched “whooping” sound
```
105
Pertussis most often affects
infants and young children and can be fatal, particularly in infants less than 1 year old
106
untreated pertussis
can lead to pneumonia, seizures, brain damage, or death
107
pertussis diagnosis
Positive culture results from a nose
| or throat specimen is considered the gold standard when diagnosing pertussis.
108
Pertussis PCR test
PCR testing of nasopharyngeal secretions offers a faster and more sensitive assay to detect the bacteria, though there is no standardized PCR protocol available
109
Pertusis Direct fluorescent antibody
| DFA
Direct fluorescent antibody (DFA) testing of nasopharyngeal specimens can also offer a rapid screening test for pertussis, though sensitivity is low
110
Pertussis: CDC testing recommendation
The CDC recommends a combination of culture and PCR assay if a patient has a cough lasting more than 3 weeks to confirm a diagnosis.
111
Pertussis lab tests
In infants, the absolute lymphocyte count often exceeds 20,000 cells/mm3
112
Pertussis chest x-ray
detect abnormalities in the lungs including the chest x-ray in perihilar infiltrates or edema; additional
findings can usually note when pneumonia complicates
pertussis.
113
The DTaP vaccine
is administered to infants and children
114
the booster vaccine Tdap
is given to adolescents and adults
115
DTaP vaccine schedule
```
one dose at each of the following ages:
2 months,
4 months,
6 months,
5 to 18 months,
and 4 to 6 years
```
116
Pertussis-containing vaccines (DTaP, Tdap) are contraindicated
for those who develop a severe allergic reaction following a previous dose or who develop encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) within 7 days after a dose of DTaP
117
DT does not contain acellular pertussis
is used as a substitute for DTaP for children who cannot tolerate the pertussis vaccine
118
Tetanus
A short-term, localized area of redness and warmth
| is common and is not predictive of future problems with tetanus immunization
119
A single dose of Tdap is recommended
for people 11 through 64 years of age.
120
“catch-up” immunization for older children (7-18 years)
schedule should
| receive one Tdap and two Td doses at the appropriate interval.
121
A booster tetanus dose
every 10 years is recommended
122
Administering the tetanus–diphtheria (Td)
| vaccine every 10 years for adolescents and adults
also assists
| in maintaining diphtheria immunity
123
Pregnant women
should receive Tdap during each of their pregnancies
| (preferably in the third trimester between the 27th and 36th week) in order to provide protection to her unborn child
124
Prior to the baby’s birth
all household members and anyone
who will be in regular close contact with the newborn
should have updated pertussis immunization
125
Pertussis herd immunity
requires over 90% of population to be up-to-date on pertussis immunization to be effective
126
Tetanus and injury
tetanus immune globulin provides temporary protection for individuals who have not received tetanus immunization
127
Tetanus and injury cont
The tetanus booster and appropriate antibiotics should also be administered, if needed.
128
Pertussis antimicrobial treatment
Macrolide abx - Azithromycin preferred
129
Infantily hypertrophic pyloric stenosis (IHPS)
risk in infants under 1 month with clarithromycin and erythromycin
130
Pertussis antimicrobial treatment - macrolide hypersensitivity
give trimethoprim-sulfamethoxazole (TMP-SMX)
131
Pertussis antimicrobial prophylaxis
consider for houshold or clost contacts of child with pertussis
132
110. Which of the following is one of the more common
sources of hepatitis A infection in the United States?
A. receiving blood products
B. ingestion of raw shellfish
C. drinking municipally sourced tap drinking water
D. ingestion of fecally contaminated food
D
133
111. When answering questions about hepatitis A vaccine, you consider stating that it:
A. contains live virus.
B. should be given to all children unless
contraindicated.
C. frequently causes systemic postimmunization
reaction.
D. is nearly 100% protective after a single injected dose.
B
134
112. The hepatitis A vaccine should be administered in
childhood per the following schedule:
A. two doses 3 months apart.
B. two doses 6 months apart.
C. two doses 1 year apart.
D. two doses are not recommended because of the
efficacy of a single dose.
B
135
113. Family members and caregivers of a child who has
been internationally adopted should optimally
be given the hepatitis A vaccine per the following
schedule:
A. two doses 6 months apart, one dose before the
child arrives.
B. two doses 3 months apart, one dose before the
child arrives.
C. two doses 1 year apart, one dose before the child
arrives.
D. one dose before the child arrives in the United
States.
A
136
```
114. Usual treatment option for a child with hepatitis A
includes:
A. interferon alpha.
B. ribavirin.
C. acyclovir.
D. supportive care.
```
D
137
115. Approximately 25% of children infected with
hepatitis A virus (HAV) develop chronic
infection. True or False
F
138
116. Suspected outbreaks of HAV infection should be
| reported to local health authorities. True or False
T
139
117. The majority of children <6 years with HAV
| infection are symptomatic. True or False
T
140
Hepatitis A infection (HAV)
caused by hepatitis A virus (HAV),a small RNA virus
141
Hepatitis A (HAV) transmission
oral-fecal contact, including through sexual and household contact ... common source foodborne outbreaks due to poor hand washing
142
The likelihood of having symptoms
| with HAV infection is related to age
children younger than
6 years of age are likely to have symptoms (>70%), whereas
older children and adults are typically asymptomatic
143
HAV SS
Symptoms, which are not specific to which type
| of hepatitis, include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice
144
HAV duration of symptoms
Signs and symptoms typically last <2 months, although 10% to 15% of symptomatic persons have disease lasting up to 6 months.
145
Hepatitis A
is typically a self-limited infection that resolves
with supportive care. Acute liver failure can occur in rare (<1%) cases, including among adults aged >50 years and in individuals with chronic liver disease
146
local public health department
should be consulted
for advice when a suspected or documented outbreak
of hepatitis A infection occurs
147
HAV vaccination recommended for
All children at 1 year of age (12–23 months),
all children and adolescents aged 2 to 18 years in communities with high incidence of HAV,
any person traveling to or from countries with intermediate- to high-risk incidence of HAV (such as adoptees),
and select high-risk groups (such as injection drug users, men who have sex with men, and persons with chronic liver disease) should be immunized against HAV
148
118. Which of the following statements is true about oral
poliovirus vaccine (OPV)?
A. It contains killed virus.
B. It is the preferred method of immunization in
North America.
C. Two doses should be administered by a child’s
fourth birthday.
D. After administration of OPV, attenuated live
poliovirus can be shed from the stool.
D
149
119. Which of the following statements is true about
inactivated poliovirus vaccine (IPV)?
A. It contains live virus.
B. It is the preferred method of immunization in
North America.
C. Two doses should be administered by a child’s
fourth birthday.
D. After administration of IPV, live poliovirus is
usually shed from the stool.
B
150
```
120. Which of the following is the route of transmission of the poliovirus?
A. fecal–oral
B. droplet
C. blood and body fluids
D. skin-to-skin contact
```
A
151
```
121. Post-polio syndrome is commonly marked by:
A. muscular hypertrophy.
B. muscle atrophy.
C. flu-like symptoms.
D. increased mortality.
```
B
152
Polioviruses
are highly contagious and capable of causing
| paralytic, life-threatening infection
153
Polioviruses
transmitted by fecal-oral route
154
Rates of infection among household contacts
may be as high as 96%
155
Most people infected with polio have no symptoms. Between 4% and 8% of those infected
have minor symptoms, including fever, fatigue, nausea, headache, flu-like symptoms, stiffness in the neck and back, and pain in the limbs, which often resolve
156
Less than 1% of polio cases result in
permanent paralysis of the limbs, usually the legs. Of those paralyzed, 5% to 10% die when the paralysis strikes the respiratory muscles
157
Post-polio syndrome (PPS)
condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. SS- slowly progressive muscle weakness, generalized and muscular fatigue, and muscle atrophy
158
Post-polio syndrome (PPS) cont
Pain from joint degeneration and increasing skeletal deformities such as scoliosis is common
and can precede the weakness and muscle atrophy
159
Since 1994
North and South America have been declared
| free of indigenous poliomyelitis
160
Polio Vaccine
An injectable vaccine that contains inactivated virus (IPV).
And OPV (live-virus, sheds in stool) not used in the US or Canada
161
Inactivated polio virus (IPV) schedule
```
Children should be given four doses of IPV at the following ages:
2 months,
4 months,
6 to 18 months,
and a booster dose at 4 to 6 years
```
162
IPV allergy
A child with a life-threatening allergy to any component of IPV, including the antibiotics neomycin, streptomycin, or polymyxin B, should not be given IVP
163
Pregnant women and IPV vaccine
not recommended per CDC guidelines
164
122. Which of the following children is most likely to have lead poisoning?
A. a developmentally disabled 5-year-old child who
lives in a 15-year-old house in poor repair
B. an infant who lives in a 5-year-old home with
copper plumbing
C. a toddler who lives in an 85-year-old home
D. a preschooler who lives near an electric generating
plant
C
165
123. Sources of lead that can contribute to plumbism include select traditional remedies such as azarcon and greta.
A. true
B. false
A
166
```
124. A diet low in the following nutrients encourages lead absorption. (Choose all that apply.)
A. protein
B. carbohydrates
C. zinc
D. magnesium
```
A and D
167
```
125. You are devising a program to screen preschoolers for lead poisoning. The most sensitive component of this campaign is:
A. environmental history.
B. physical examination.
C. hematocrit level.
D. hemoglobin electrophoresis.
```
A
168
```
126. Patients with plumbism present with which kind of
anemia?
A. macrocytic, hyperchromic
B. normocytic, normochromic
C. hemolytic
D. microcytic, hypochromic
```
D
169
```
127. At which of the following ages should screening begin for a child who has significant risk of lead poisoning?
A. 3 months
B. 6 months
C. 1 year
D. 2 years
```
B
170
128. Intervention for a child with a lead level of 5 to
44 mcg/dL usually includes all of the following except:
A. removal from the lead source.
B. iron supplementation.
C. chelation therapy.
D. encouraging a diet high in vitamin C.
C
171
```
129. Intervention for a child with a lead level of 45 to
50 mcg/dL or greater usually includes:
A. chelation therapy.
B. calcium supplementation.
C. exchange transfusion.
D. iron depletion therapy
```
A
172
Lead poisoning, or plumbism
leads to the development of a microcytic,
| hypochromic anemia; basophilic stippling is often noted on red blood cell morphology
173
Lead poisoning, or plumbism
toxic to the solid organs, bones, and nervous system
174
Longterm complications of lead poisoning
include behavior or attention problems, poor academic performance, hearing problems, kidney damage, reduced IQ, and slowed body growth
175
Lead poisoning is caused
by exposure to lead in the environment.
| The major source in children is lead-based paint
176
Lead paint
Leadbased paint has not been available for household use in the United States since 1978.
177
Lead paint in 1950s
most homes built before 1957 contain lead-based paint
178
Diet that enhances oral lead absorption
A diet low in calcium, iron, zinc, magnesium, and copper and high in fat, which is a typical diet
for children living in poverty, enhances oral lead absorption
179
Highest age for risk of lead poisoning
2-3 years - high lead concentration on windowsills, children are drawn to windows esp in the summer
180
Lead poisoning occurs when
Inhalation of paint dust is a potent lead source
for infants and for children with lead levels of less than
45 mcg/dL,
181
Lead posioning with higher levels
toddlers and children with lead levels of
| more than 45 mcg/dL are typically poisoned by also eating paint chips
182
household products contain lead hazards
traditional home health remedies such as azarcon and great, which are used for upset stomach or indigestion in the Latino and other ethnic communities, and select imported products including candies, toys, jewelry, cosmetics, pottery, and ceramics.
183
Other sources of lead hazards
Additional sources include drinking water contaminated by lead leaching from lead pipes, solder, brass fixtures, or valves and consumer products, including tea kettles and vinyl blinds
184
Clinical manifestation of lead poisoning
is usually not apparent until a child’s lead level is markedly elevated
185
Symptoms of elevated lead levels
include abdominal pain and cramping, aggressive behavior, anemia, constipation, difficulty
sleeping, headaches, irritability, loss of previous developmental skills in young children, low appetite and energy levels, and reduced sensations
186
Very high levels of lead
can result in vomiting, staggering walk, muscle weakness, seizures, or coma.
187
periodic screening of all children is recommended for lead poisoning
most children have low-level exposure or
| chronic lead exposure with few or no symptoms
188
Primary prevention of lead poisoning should be the goal
to reduce the risk for all children
189
If lead risk is identified
the child should removed or the exposure limited
190
Blood level for elevated blood lead
A measure of ≥5 mcg/dL is now used to identify children with elevated blood lead levels
191
Lead levels of 5 - 44 mcg/dL
Most children with lead levels
| of 5 to 44 mcg/dL are treated with removal from the source, improved nutrition, and iron therapy
192
Lead levels of 45 - 50 mcd/dL
Those with lead levels of 45 to 50 mcg/dL are treated with a chelation agent such as succimer, in addition to the previously listed interventions
193
Lead levels greater than 51 mcg/dL
For children with lead levels of greater than 51 mcg/dL, hospital admission with expert evaluation is likely the most prudent course of action to avoid serious problems (including encephalopathy)
associated with markedly elevated lead levels
194
Do not give varicella and MMR vaccine before age
of 12 months
195
Youngest age for influenza vaccine
is 6 months
196
Only vaccine given at birth
is hepatitis B
197
If HBsAg-positive mother
give the neonate hepatitis B immunoglobulin (HBIG)
| and the hepatitis B vaccine.
198
Do not use DTaP
if age 7 years or older
199
Use Td or Tdap
if over 7 years old
200
Give Tdap vaccine at age of
11-12 years as a booster
201
If older than 11 or 12 years
replace one dose of Td with a Tdap (once in a lifetime)
202
Any vaccine that has a time range (e.g., third dose of IPV can be given from 6 to 18
months; third dose of hepatitis B can be given between 6 and 18 months)
does not appear on the exam (boards)
203
At what age is Hep B given as the first dose
birth
204
Is Hep B vaccine oral or IM
IM
205
What age range can the second dose of Hep B be given
1-2 months
206
What age range can the third vaccination of Hep B be given
6-18 months
207
What two vaccines can be given in combination with Hep B
DTap and IPV
208
What type of vaccine is Rotavirus
oral
209
Contraindications for the Rotavirus vaccine
Do not give to a child with a history of Intussusception
Severe latex Allergy
Severe Combined Immunodeficiency
Moderate-severe gastroenteritis
210
An infant’s mother received a biologic response modifier, Enanercept, during pregnancy. What vaccine should NOT be given to the infant/is a contraindication?
Rotavirus
211
What is the leading medical diagnosis cause of hospitalization and death in young children worldwide from Rotavirus?
Acute gastroenteritis
212
When can the first dose of Varicella be administered? How early can the second dose be administered after the first? What age range could the second dose also be administered at?
12 months old. 3 months after 1st (15 months). 4 – 6 years old.
213
What can be given in combination with Varicella? What is it called?
MMR
| MMRV
214
What are contraindications of Varicella vaccine? Is this a Live vaccine? What is a precaution?
Live vaccine.
Children with acquired varicella
T-Cell abnormalities – can be given to HIV children that are NOT immunocompromised
Pregnancy!!!
Precaution: history of febrile seizures if giving the combination vaccine (may cause adverse event or diminish vaccine effectiveness)
215
What substance is in the Varicella vaccine that can cause a severe anaphylactic reaction if the child is given varicella?
Neomycin
216
What age range is the first dose of Hepatitis A vaccine given? Second?
12 – 15 months
| 6 months later
217
What are some adverse reactions of the Hepatitis A vaccine?
pain, swelling, induration at the injection site
| headache and loss of appetite
218
What ages are the Inactivated Polio (IPV) vaccine given? What is the age range of the 3rd dose?
2, 4, 6 months of age. 3rd dose can be given 6 – 18 months of age
219
Is there a fourth dose of IPV? What is the recommended age of the 4th dose? How long should the provider wait after the dose?
yes, 4 or more doses of IPV can be given before age 4 years (combination vaccines). A dose is still RECOMMENDED at age 4 to 6 years (Booster MUST be 6 months after the previous dose?)
220
What three vaccines can be given in combination to IPV?
DTaP, Hep B, or Hib
221
A child with _______ illness, with or without the presence of ______, should not be given IPV.
moderate-severe illness. Fever
222
What is in the IPV vaccine that can cause anaphylaxis if the child is allergic to this?
NEOMYCIN, STREPTOMYCIN, POLYMYXIN B
