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unit 1 71 > Vaccines > Flashcards

Vaccines Flashcards

1
Q
  1. 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

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2
Q
  1. 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

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3
Q
  1. 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

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4
Q
  1. 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

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5
Q 
62. Which of the following viruses is a potent teratogen?
A. measles
B. mumps
C. rubella
D. influenza
A

C

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6
Q
  1. Evidence demonstrates that the MMR virus
    acquired via vaccine can be shed into the body
    during lactation.
    A. true
    B. false
A

B

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7
Q
  1. 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

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8
Q
  1. 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

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9
Q
  1. 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

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10
Q
  1. 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

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11
Q
  1. 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

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12
Q
  1. 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

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13
Q
  1. 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

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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

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15
Q
  1. 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

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16
Q
  1. 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

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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.

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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

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19
Q

High risk of serious flu-related complications

A

• Women who are or will be pregnant during the influenza season

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20
Q

High risk of serious flu-related complications

A

• All children aged 6 through 59 months

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21
Q

High risk of serious flu-related complications

A

• Individuals age 50 years of age and older

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22
Q

High risk of serious flu-related complications

A

• Individuals of any age with certain chronic medical conditions or who have immunosuppression

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23
Q

High risk of serious flu-related complications

A

• Residents of nursing homes and other long-term care facilities

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24
Q

High risk of serious flu-related complications

A

• Persons who are extremely obese (BMI ≥40 kg/m2)

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25
Q

High risk of serious flu-related complications

A

• 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)

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26
Q

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

A

can safely receive the influenza vaccine

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27
Q

Recombinant influenza vaccine (RIV; FluBlok®)

A

egg-free vaccine preparation that can be considered

for patients with a history of severe allergic reaction to eggs.

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28
Q
  1. 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.
A

C

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29
Q
  1. 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.
A

D

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30
Q
  1. 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.
A

C

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31
Q
  1. 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.
A

B

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32
Q
  1. 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
A

B

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33
Q
  1. 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.
A

B

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34
Q
  1. 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

A

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35
Q 
81. Universal infant vaccination against HBV was recommended
in what year?
A. 1972
B. 1978
C. 1982
D. 1991
A

D

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36
Q 
82. Routine adolescent vaccination against HBV was
recommended in what year?
A. 1996
B. 1991
C. 1982
D. 1978
A

A

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37
Q
  1. 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
A

D

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38
Q

HBV vaccine is recommended routinely for all infants

and is administered in

A

three-injection series at 0, 1, and

6 months of age.

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39
Q

The MMR vaccine

A

is a live, attenuated vaccine

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40
Q

MMR vaccine: The recommended

schedule for early childhood immunization

A

is two doses of MMR vaccine, one given between ages 12 and 15 months and one between 4 and 6 years

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41
Q

Infants traveling abroad

A

The CDC recommends giving one dose of MMR

to infants 6 through 11 months of age if traveling outside of the United States

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42
Q

MMR vaccine: older children

who were not immunized earlier in life

A

Two immunizations 1 month apart are recommended

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43
Q

Rubella

A

potent teratogen - causes congenital rubella syndrome

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44
Q

MMR vaccine: contraindicated when?

A

pregnancy - may pass to unborn child

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45
Q

Verify immunity to measles, mumps, or rubella

A

documentation of vaccination, laboratory

evidence of disease, birth date before 1957, or laboratory evidence of immune markers

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46
Q

2-dose HBV vaccine

A

approved by the U.S. Food and Drug Administration

(FDA) for adolescents and adults

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47
Q

HBV vaccine series is intrurrupted after first dose

A

second dose should be administered as soon as possible

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48
Q

HBV vaccine series is intrurrupted after first dose

A

second and third doses should be separated by 8 week interval (second dose can be given as soon as possible).

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49
Q

2-dose HBV vaccine

A

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

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50
Q

Infants who have been infected perinatally with

HBV

A

have an estimated 25% lifetime chance of developing

hepatocellular carcinoma or cirrhosis

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51
Q

During the first 24 hours of life, a neonate born to a

mother with HBV

A 
should receive HBV vaccine and hepatitis B
immune globulin (HBIG) to minimize the risk of perinatal transmission
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52
Q

If maternal HBsAg status is unknown

A

consideration should be given to testing the child for evidence of perinatal acquisition of HBV infection

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53
Q

Without intervention, the risk for chronic HBV infection

A

is 70% to 90% by age 6 months in a newborn infant whose mother is positive for both HBsAg and HBeAg

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54
Q

Without intervention, the risk for chronic HBV infection

A

<10% for

infants of women who are HBsAg positive but HBeAg negative.

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55
Q

HBV vaccine and one dose of HBIG administered within 24 hours after birth

A

85% to 95% effective in preventing

both acute HBV infection and chronic infection

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56
Q
  1. 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.
A

D

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57
Q 
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.
A

C

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58
Q
  1. 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.
A

D

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59
Q 
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
A

C

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60
Q
  1. 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.
A

B

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61
Q 
89. How is the varicella virus most commonly transmitted?
A. droplet transmission
B. contact with inanimate reservoirs
C. contact transmission
D. waterborne transmission
A

A

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62
Q
  1. 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
A

B,D

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63
Q 
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

A

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64
Q
  1. 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.
A

B

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65
Q 
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

A

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66
Q

About 15% of people who have had

chickenpox

A

develop shingles at least once during their lifetime

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67
Q

Varicella virus transmission is

A

transmitted via respiratory droplet and contact with open lesions

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68
Q

Chickenpox can be serious in:

A

infants or immunocompromised

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69
Q

Complications of varicella

A

bacterial infection of skin lesions, pneumonia, encephalitis, toxic shock syndrome, and Reye’s syndrome (for those taking aspirin during infection).

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70
Q

Varicella: measurement of immunity

A
  • patient reported history
  • serological evidence of immunity
  • individuals born before 1980
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71
Q

Who should have varicella serological testing to show immunity?

A

pregnant women and immunocompromised

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72
Q

Varicella titers should be done for?

A

healthcare workers

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73
Q

Varicella vaccine contains?

A

live attenuated virus

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74
Q

Varicella vaccine is administered

A

in two doses, one at age 1 year and the second at age 4 to 6 years

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75
Q

Older children and adults with no history of varicella infection or previous immunization

A

should receive two immunizations 4 to 8 weeks

apart

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76
Q

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

A

Should be targeted for varicella vaccine

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77
Q

mild forms of chickenpox

A

are occasionally reported after immunization

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78
Q

Pregnant women and varicella

A

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

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79
Q

varicella infection occurs during the first 20 weeks of pregnancy (particularly between 8 and 20 weeks)

A

the fetus is at risk of developing
congenital varicella syndrome, which can cause skin scarring, underdeveloped limbs, eye inflammation, and incomplete brain development

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80
Q

Infection occurring within days of delivery

A

neonatal varicella, which is potentially

life-threatening

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81
Q

vaccination within 3 to 5 days of exposure to

A

varicella is beneficial in preventing or modifying the disease

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82
Q
  1. 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
A

C

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83
Q
  1. 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

A

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84
Q
  1. 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

A

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85
Q 
97. Infection with Corynebacterium diphtheriae usually
causes:
A. a diffuse rash.
B. meningitis.
C. pseudomembranous pharyngitis.
D. a gastroenteritis-like illness.
A

C

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86
Q 
98. Pertussis is primarily spread via:
A. contact with a contaminated surface.
B. respiratory droplet.
C. blood contact.
D. skin-to-skin contact.
A

B

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87
Q 
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

A

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88
Q
  1. 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.
A

D

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89
Q
  1. 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
A

B,D

90
Q
  1. 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
A

B

91
Q 
103. The preferred treatment option for a 6-year-old boy with demonstrated pertussis is:
A. amoxicillin.
B. ceftriaxone.
C. azithromycin.
D. levofloxacin.
A

C

92
Q
  1. 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

A

93
Q
  1. 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.
A

D

94
Q
  1. 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.
A

B

95
Q 
107. The incubation period for pertussis is up to:
A. 3 days.
B. 10 days.
C. 3 weeks.
D. 3 months.
A

C

96
Q 
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%
A

D

97
Q
  1. Effective herd immunity against pertussis requires
    of the population being up-to-date on pertussis
    immunization.
    A. 30%
    B. 50%
    C. 75%
    D. >90%
A

D

98
Q

Clostridium tetani

A

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
Q

Tetanus

A

enters the body through a contaminated wound

and causes a life-threatening systemic disease characterized by painful muscle weakness and spasm (“lockjaw”).

100
Q

Diphtheria

A

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
Q

Diphtheria is characterized by

A

severe respiratory tract infection, including

the appearance of pseudomembranous pharyngitis

102
Q

Pertussis, or whopping cough

A

is a highly contagious disease that is passed from person to person by droplets from coughing or sneezing.

103
Q

Pertussis

A

Symptoms of pertussis usually develop within 7 to 10 days after being exposed, but they may appear up to 6 weeks later

104
Q

Pertussis causes

A 
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
Q

Pertussis most often affects

A

infants and young children and can be fatal, particularly in infants less than 1 year old

106
Q

untreated pertussis

A

can lead to pneumonia, seizures, brain damage, or death

107
Q

pertussis diagnosis

A

Positive culture results from a nose

or throat specimen is considered the gold standard when diagnosing pertussis.

108
Q

Pertussis PCR test

A

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
Q

Pertusis Direct fluorescent antibody

DFA

A

Direct fluorescent antibody (DFA) testing of nasopharyngeal specimens can also offer a rapid screening test for pertussis, though sensitivity is low

110
Q

Pertussis: CDC testing recommendation

A

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
Q

Pertussis lab tests

A

In infants, the absolute lymphocyte count often exceeds 20,000 cells/mm3

112
Q

Pertussis chest x-ray

A

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
Q

The DTaP vaccine

A

is administered to infants and children

114
Q

the booster vaccine Tdap

A

is given to adolescents and adults

115
Q

DTaP vaccine schedule

A 
one dose at each of the following ages: 
2 months,
4 months, 
6 months, 
5 to 18 months, 
and 4 to 6 years
116
Q

Pertussis-containing vaccines (DTaP, Tdap) are contraindicated

A

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
Q

DT does not contain acellular pertussis

A

is used as a substitute for DTaP for children who cannot tolerate the pertussis vaccine

118
Q

Tetanus

A

A short-term, localized area of redness and warmth

is common and is not predictive of future problems with tetanus immunization

119
Q

A single dose of Tdap is recommended

A

for people 11 through 64 years of age.

120
Q

“catch-up” immunization for older children (7-18 years)

A

schedule should

receive one Tdap and two Td doses at the appropriate interval.

121
Q

A booster tetanus dose

A

every 10 years is recommended

122
Q

Administering the tetanus–diphtheria (Td)

vaccine every 10 years for adolescents and adults

A

also assists

in maintaining diphtheria immunity

123
Q

Pregnant women

A

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
Q

Prior to the baby’s birth

A

all household members and anyone
who will be in regular close contact with the newborn
should have updated pertussis immunization

125
Q

Pertussis herd immunity

A

requires over 90% of population to be up-to-date on pertussis immunization to be effective

126
Q

Tetanus and injury

A

tetanus immune globulin provides temporary protection for individuals who have not received tetanus immunization

127
Q

Tetanus and injury cont

A

The tetanus booster and appropriate antibiotics should also be administered, if needed.

128
Q

Pertussis antimicrobial treatment

A

Macrolide abx - Azithromycin preferred

129
Q

Infantily hypertrophic pyloric stenosis (IHPS)

A

risk in infants under 1 month with clarithromycin and erythromycin

130
Q

Pertussis antimicrobial treatment - macrolide hypersensitivity

A

give trimethoprim-sulfamethoxazole (TMP-SMX)

131
Q

Pertussis antimicrobial prophylaxis

A

consider for houshold or clost contacts of child with pertussis

132
Q
  1. 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
A

D

133
Q
  1. 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.
A

B

134
Q
  1. 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.
A

B

135
Q
  1. 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

A

136
Q 
114. Usual treatment option for a child with hepatitis A
includes:
A. interferon alpha.
B. ribavirin.
C. acyclovir.
D. supportive care.
A

D

137
Q
  1. Approximately 25% of children infected with
    hepatitis A virus (HAV) develop chronic
    infection. True or False
A

F

138
Q
  1. Suspected outbreaks of HAV infection should be

reported to local health authorities. True or False

A

T

139
Q
  1. The majority of children <6 years with HAV

infection are symptomatic. True or False

A

T

140
Q

Hepatitis A infection (HAV)

A

caused by hepatitis A virus (HAV),a small RNA virus

141
Q

Hepatitis A (HAV) transmission

A

oral-fecal contact, including through sexual and household contact … common source foodborne outbreaks due to poor hand washing

142
Q

The likelihood of having symptoms

with HAV infection is related to age

A

children younger than
6 years of age are likely to have symptoms (>70%), whereas
older children and adults are typically asymptomatic

143
Q

HAV SS

A

Symptoms, which are not specific to which type

of hepatitis, include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice

144
Q

HAV duration of symptoms

A

Signs and symptoms typically last <2 months, although 10% to 15% of symptomatic persons have disease lasting up to 6 months.

145
Q

Hepatitis A

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
Q

local public health department

A

should be consulted
for advice when a suspected or documented outbreak
of hepatitis A infection occurs

147
Q

HAV vaccination recommended for

A

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
Q
  1. 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.
A

D

149
Q
  1. 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.
A

B

150
Q 
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

A

151
Q 
121. Post-polio syndrome is commonly marked by:
A. muscular hypertrophy.
B. muscle atrophy.
C. flu-like symptoms.
D. increased mortality.
A

B

152
Q

Polioviruses

A

are highly contagious and capable of causing

paralytic, life-threatening infection

153
Q

Polioviruses

A

transmitted by fecal-oral route

154
Q

Rates of infection among household contacts

A

may be as high as 96%

155
Q

Most people infected with polio have no symptoms. Between 4% and 8% of those infected

A

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
Q

Less than 1% of polio cases result in

A

permanent paralysis of the limbs, usually the legs. Of those paralyzed, 5% to 10% die when the paralysis strikes the respiratory muscles

157
Q

Post-polio syndrome (PPS)

A

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
Q

Post-polio syndrome (PPS) cont

A

Pain from joint degeneration and increasing skeletal deformities such as scoliosis is common
and can precede the weakness and muscle atrophy

159
Q

Since 1994

A

North and South America have been declared

free of indigenous poliomyelitis

160
Q

Polio Vaccine

A

An injectable vaccine that contains inactivated virus (IPV).

And OPV (live-virus, sheds in stool) not used in the US or Canada

161
Q

Inactivated polio virus (IPV) schedule

A 
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
Q

IPV allergy

A

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
Q

Pregnant women and IPV vaccine

A

not recommended per CDC guidelines

164
Q
  1. 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
A

C

165
Q
  1. Sources of lead that can contribute to plumbism include select traditional remedies such as azarcon and greta.
    A. true
    B. false
A

A

166
Q 
124. A diet low in the following nutrients encourages lead absorption. (Choose all that apply.)
A. protein
B. carbohydrates
C. zinc
D. magnesium
A

A and D

167
Q 
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

A

168
Q 
126. Patients with plumbism present with which kind of
anemia?
A. macrocytic, hyperchromic
B. normocytic, normochromic
C. hemolytic
D. microcytic, hypochromic
A

D

169
Q 
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
A

B

170
Q
  1. 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.
A

C

171
Q 
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

A

172
Q

Lead poisoning, or plumbism

A

leads to the development of a microcytic,

hypochromic anemia; basophilic stippling is often noted on red blood cell morphology

173
Q

Lead poisoning, or plumbism

A

toxic to the solid organs, bones, and nervous system

174
Q

Longterm complications of lead poisoning

A

include behavior or attention problems, poor academic performance, hearing problems, kidney damage, reduced IQ, and slowed body growth

175
Q

Lead poisoning is caused

A

by exposure to lead in the environment.

The major source in children is lead-based paint

176
Q

Lead paint

A

Leadbased paint has not been available for household use in the United States since 1978.

177
Q

Lead paint in 1950s

A

most homes built before 1957 contain lead-based paint

178
Q

Diet that enhances oral lead absorption

A

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
Q

Highest age for risk of lead poisoning

A

2-3 years - high lead concentration on windowsills, children are drawn to windows esp in the summer

180
Q

Lead poisoning occurs when

A

Inhalation of paint dust is a potent lead source
for infants and for children with lead levels of less than
45 mcg/dL,

181
Q

Lead posioning with higher levels

A

toddlers and children with lead levels of

more than 45 mcg/dL are typically poisoned by also eating paint chips

182
Q

household products contain lead hazards

A

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
Q

Other sources of lead hazards

A

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
Q

Clinical manifestation of lead poisoning

A

is usually not apparent until a child’s lead level is markedly elevated

185
Q

Symptoms of elevated lead levels

A

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
Q

Very high levels of lead

A

can result in vomiting, staggering walk, muscle weakness, seizures, or coma.

187
Q

periodic screening of all children is recommended for lead poisoning

A

most children have low-level exposure or

chronic lead exposure with few or no symptoms

188
Q

Primary prevention of lead poisoning should be the goal

A

to reduce the risk for all children

189
Q

If lead risk is identified

A

the child should removed or the exposure limited

190
Q

Blood level for elevated blood lead

A

A measure of ≥5 mcg/dL is now used to identify children with elevated blood lead levels

191
Q

Lead levels of 5 - 44 mcg/dL

A

Most children with lead levels

of 5 to 44 mcg/dL are treated with removal from the source, improved nutrition, and iron therapy

192
Q

Lead levels of 45 - 50 mcd/dL

A

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
Q

Lead levels greater than 51 mcg/dL

A

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
Q

Do not give varicella and MMR vaccine before age

A

of 12 months

195
Q

Youngest age for influenza vaccine

A

is 6 months

196
Q

Only vaccine given at birth

A

is hepatitis B

197
Q

If HBsAg-positive mother

A

give the neonate hepatitis B immunoglobulin (HBIG)

and the hepatitis B vaccine.

198
Q

Do not use DTaP

A

if age 7 years or older

199
Q

Use Td or Tdap

A

if over 7 years old

200
Q

Give Tdap vaccine at age of

A

11-12 years as a booster

201
Q

If older than 11 or 12 years

A

replace one dose of Td with a Tdap (once in a lifetime)

202
Q

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)

A

does not appear on the exam (boards)

203
Q

At what age is Hep B given as the first dose

A

birth

204
Q

Is Hep B vaccine oral or IM

A

IM

205
Q

What age range can the second dose of Hep B be given

A

1-2 months

206
Q

What age range can the third vaccination of Hep B be given

A

6-18 months

207
Q

What two vaccines can be given in combination with Hep B

A

DTap and IPV

208
Q

What type of vaccine is Rotavirus

A

oral

209
Q

Contraindications for the Rotavirus vaccine

A

Do not give to a child with a history of Intussusception
Severe latex Allergy
Severe Combined Immunodeficiency
Moderate-severe gastroenteritis

210
Q

An infant’s mother received a biologic response modifier, Enanercept, during pregnancy. What vaccine should NOT be given to the infant/is a contraindication?

A

Rotavirus

211
Q

What is the leading medical diagnosis cause of hospitalization and death in young children worldwide from Rotavirus?

A

Acute gastroenteritis

212
Q

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?

A

12 months old. 3 months after 1st (15 months). 4 – 6 years old.

213
Q

What can be given in combination with Varicella? What is it called?

A

MMR

MMRV

214
Q

What are contraindications of Varicella vaccine? Is this a Live vaccine? What is a precaution?

A

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
Q

What substance is in the Varicella vaccine that can cause a severe anaphylactic reaction if the child is given varicella?

A

Neomycin

216
Q

What age range is the first dose of Hepatitis A vaccine given? Second?

A

12 – 15 months

6 months later

217
Q

What are some adverse reactions of the Hepatitis A vaccine?

A

pain, swelling, induration at the injection site

headache and loss of appetite

218
Q

What ages are the Inactivated Polio (IPV) vaccine given? What is the age range of the 3rd dose?

A

2, 4, 6 months of age. 3rd dose can be given 6 – 18 months of age

219
Q

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?

A

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
Q

What three vaccines can be given in combination to IPV?

A

DTaP, Hep B, or Hib

221
Q

A child with _______ illness, with or without the presence of ______, should not be given IPV.

A

moderate-severe illness. Fever

222
Q

What is in the IPV vaccine that can cause anaphylaxis if the child is allergic to this?

A

NEOMYCIN, STREPTOMYCIN, POLYMYXIN B

unit 1 71 (5 decks)

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