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Multiple choice questions on
immunisation against infectious disease
The Green Book
Original version issued February 2008
Updated version October 2015
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)bout #ublic "ealth ngland
#ublic "ealth ngland e!ists to protect and i$prove the nation*s health and
+ellbeing, and reduce health ine-ualities. /t does this through +orld%classscience, kno+ledge and intelligence, advocacy, partnerships and the delivery o
specialist public health services. #" is an operationally autono$ous e!ecutive
agency o the epart$ent o "ealth.
#ublic "ealth nglandellington "ouse133%155 aterloo 4oadondon 61 8UGTel7 020 95: 8000+++.gov.uk;phe
T+itter7 'ro+n copyright 201:This publication is licensed under the ter$s o the Open Govern$ent icencev3.0 e!cept +here other+ise stated. To vie+ this licence, visit7nationalarchives.gov.uk;doc;open%govern$ent%licence;version;3 or+rite to the/nor$ation #olicy Tea$, The ?ational )rchives, @e+, ondon TA :U, or
e$ail7 psi
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These $ultiple choice -uestions have been devised to help you test your
kno+ledge and understanding o each o the chapters o the *Green Book
/$$unisation against inectious disease*. To $ake best use o the $ultiple choice
-uestions as a learning and revision tool +e reco$$end that you read a chapter
in detail beore atte$pting the relevant -uestions. e have also prepared anans+er key.
To receive this ans+er key please e %$ail esse!hpt
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'ontents (uestions
'hapter 1 /$$unity and "o+ Iaccines ork :
'hapter 2 'onsent 9
'hapter 3 'old 'hain
'hapter : /$$unisation #rocedures 8
'hapter 5 /$$unisation by ?urses and Other #roessionals 10
'hapter 9 'ontraindications and special considerations 11
'hapter /$$unisation o Those +ith Underlying &edical 'onditions 13
'hapter 8 Iaccine 6aety and )dverse vents Follo+ing /$$unisation 15
'hapter A 6urveillance and &onitoring or Iaccine 6aety 1
'hapter 10 Iaccine a$age #ay$ent 6che$e 18
'hapter 11 /$$unisation 6chedule 21'hapter 12 /$$unisation o "ealthcare and aboratory 6ta 2:
'hapter 13 )nthra! 25
'hapter 1: 'holera 2
'hapter 15 iphtheria 30
'hapter 19 "ae$ophilus /nluenJa Type B "ibH 32
'hapter 1 "epatitis ) 3:
'hapter 18 "epatitis B 39
'hapter 18a "u$an #apillo$avirus 3A
'hapter 1A /nluenJa :1'hapter 20 Kapanese ncephalitis KH ::
'hapter 21 &easles :9
'hapter 22 &eningococcal :8
'hapter 2: #ertussis 5:
'hapter 25 #neu$ococcal 55
'hapter 29 #olio 5A
'hapter 2 4abies 91
'hapter 2a 4espiratory 6yncytial Iirus 93
'hapter 2b % 4otavirus 95
'hapter 28 4ubella 9
'hapter 28a % 6hingles 9A
'hapter 2A % 6$allpo! 1
'hapter 30 Tetanus 2
'hapter 31 Tick borne ncephalitis TBH :
'hapter 32 Tuberculosis 5
'hapter 33 Typhoid 8
'hapter 3: Iaricella 81
'hapter 35 Lello+ Fever 8:
:
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'hapter 1 /$$unity and ho+ vaccines
+ork
1. Which of the following confer(s) passive immunity:
aH "epatitis B vaccine
bH &&4 vaccine
cH "epatitis B i$$unoglobulin
dH /nection +ith $easles virus
eH 'ross placental transer o $aternal antibodies
2. Immunogloulins are made:
aH /n a laboratory ro$ deactivated viruses and bacteria
bH Fro$ the plas$a o a person in the acute phase o an inectious
disease
cH Fro$ the pooled plas$a o blood donors
dH Fro$ protein produced artiicially in a laboratory
eH Fro$ treating red blood cells
!. In the immune system:
aH B ly$phocytes secrete antibodies
bH Iaccines provide passive i$$unity
cH B cells sti$ulate T cells to produce antibodies
dH 'ell%$ediated i$$unity is controlled by T ly$phocytes
eH &acrophages neutralise to!ins
". Which of the following is#are true aout con$ugated vaccines:
aH 'onEugated vaccines are those in +hich there is $ore than one
vaccine antigen eg &&4
bH 'onEugated vaccines tend to induce a poorer response than
polysaccharide vaccines
cH &eningitis ' vaccine is not available in a conEugated or$
dH "ib vaccine is an e!a$ple o a conEugated vaccine
eH 'onEugation involves attaching a polysaccharide antigen to a
carbohydrate carrier
:
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%. Which of the following is#are true:
aH /$$unological $e$ory is only present i there are detectable
antibodies
bH The response to vaccine antigen is do$inated by /gG initially
ollo+ed by /g&
cH "erd i$$unity reduces the risk o unvaccinated individuals being
e!posed to inection
dH #ertussis vaccine contains an inactivated to!in to!oidH
eH B'G is a live vaccine
&. 'pecific immunogloulins are availale for:
aH 4abies
bH #ertussis
cH Tetanus
dH 4ubella
eH Iaricella Moster
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'hapter 2 'onsent
1. onsent to immunisation:
aH &ust be obtained in +riting
bH ?eed only be obtained once, provided it is docu$ented
cH /s voluntary
dH 'an be given by a person aged 19 years or the$selves
eH 6hould include provision o inor$ation on the process, beneits
and risks o i$$unisation
2. efore administering an immunisation one should:
aH 'onir$ the person still gives their consent
bH nsure the person bringing a child or i$$unisation has parental
responsibility or the child
cH Obtain the consent in +riting
dH nsure consent is docu$ented in the patientDs records
eH 'onir$ the person;parent understands +hat is happening
!. Which of the following people may give consent to immunisation:
aH )n adult or the$selves
bH ) child o any age +ho can de$onstrate NGillick co$petence
cH The ne!t o kin o an adult unable to given their o+n consent
dH The natural ather o a child, i na$ed on the birth certiicate
eH )ny person +ith parental responsibility or a child
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'hapter 3 'old chain
1. Maintaining the cold chain ensures that vaccines are stored
according to the manufacturer*s instructions at:
aH 0oto P:
o'
bH %1oto P5
o'
cH P2oto P10
o'
dH P:oto P8
o'
eH P2oto P8
o'
2. Which of the following is#are true of a vaccine refrigerator:
aH )n ordinary do$estic rerigerator is suicient provided it has only
vaccines stored in it
bH 'an be used to store urine sa$ples
cH 6hould be lockable or in a lockable roo$
dH 6hould be a+ay ro$ radiators
eH )re best plugged into a s+itchless socket
!. +accines should e:
aH Taken out o their original packaging to save space in the
rerigerator
bH 6tored in the botto$ dra+ers o the rerigerator
cH #acked tightly in the rerigerator
dH #rotected ro$ light during storage
eH ?ever be given to patients to transport or store
". Immunogloulins:
aH 6hould be protected ro$ light
bH 6hould be stored at P2oto P8
o'
cH &ay be roJen
dH ill tolerate roo$ te$peratures or up to one +eek, but should be
rerigerated
eH &ay be sent by post
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'hapter : /$$unisation procedures
1. Which of the following vaccines is#are given y the intramuscular
route:
aH /nluenJa
bH B'G
cH 'holera
dH &&4
eH Iaricella
2. ,he most suitale site(s) for intramuscular and sucutaneous
vaccination is#are:
aH )nterolateral aspect o the thigh
bH eltoid area o the upper ar$
cH Fatty area o buttock
dH )ny+here in buttock
eH )ll o the above
!. Which of the following is#are true when giving a vaccine:
aH / the skin is clean no urther cleaning is necessary
bH The skin should be disinected prior to ad$inistering any vaccine
cH Only visibly dirty skin needs to be +ashed +ith soap and +ater
dH The needle should be suiciently long 25$$H or all ages e!cept
or pre%ter$ and very s$all children
eH 6kin should be stretched, not bunched
". -fter giving a vaccine you should always:
aH Observe the recipient or i$$ediate adverse reactions )4sH
bH @eep the recipient under longer observation in the surgery
cH ispose o e-uip$ent used or vaccination in a CsharpsD bo!
dH @eep accurate and accessible records o both the recipient and
the vaccine given
eH )ll o the above
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%. Which of the following is#are true aout vaccine administration:
aH /t is better to inEect vaccine into at than $uscle
bH ) 25$$ needle length is suitable or all age groups
cH ) 19$$ needle length is only reco$$ended or pre%ter$ or very
s$all inants
dH The deltoid area o the upper ar$ is generally preerred or inants
under 1 year old
eH The anterolateral region o the thigh is generally preerred or
older children and adults
&. If given in the same lim as another vaccine the second vaccine
should e separated y at least:
aH 0.5c$bH 1.5c$
cH 2.5c$
dH 3.5c$
eH ?one o the above
A
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'hapter 5 /$$unisation by nurses
and other proessionals
1. /atient group directions (/0s):
aH 'an be used to ad$inister an unlicensed vaccine
bH 6hould state that a Black Triangle $edicine is being used
cH )re verbal instructions or the supply or ad$inistration o
$edicines to a group o patients +ho $ay not be individually
identiied beore presentation
dH )re legally re-uired to be revie+ed at least every t+o years
eH )re a or$ o prescribing vaccines
2. - patient group direction (/0) must e signed y:
aH ) senior nurse and a senior doctor
bH ) senior nurse and a senior phar$acist
cH ) senior doctor and a senior phar$acist
dH ) practice $anager and a G#
eH T+o nurse prescribers
!. - patient specific direction (/'):
aH 6hould not be used in preerence to a patient group direction
bH /s the usual $ethod or the supply and ad$inistration o vaccines in
the routine childhood i$$unisation schedule
cH oes not re-uire the patient;s to be na$ed
dH 'an be a verbal instruction in a busy clinic situation
eH )llo+s a prescriber to instruct another health proessional in
+riting to supply or ad$inister a $edicine
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'hapter 9 'ontraindications and
special considerations
1. +accination with a live vaccine should e deferred if:
aH The patient has received i$$unoglobulin in the past three $onths
bH The patient is receiving syste$ic high%dose steroids
cH The patient is a pre$ature inant
dH The patient has a ebrile illness
eH The patient has a a$ily history o epilepsy
2. Which of the following is#are contraindications to all vaccines:
aH )n allergy to eggs
bH #regnancy
cH 4eceiving i$$unoglobulin in the past three $onths
dH ) docu$ented history o the disease
eH #ersonal history o ebrile convulsion
!. /atients with the following conditions may safely e given any
immunisation:
aH )sth$a
bH o+ birth +eight
cH "/I
dH Thy$us disorders thy$ic cancer, $yasthenia gravis, a history o
thy$ecto$yH
eH ) history o Eaundice at birth
". - severely immunocompromised patient can receive the followingvaccines:
aH iphtheria;tetanus;inactivated polio co$bined Td;/#IH
bH &&4
cH #neu$ococcal conEugate
dH "epatitis B
eH "ib;&en' co$bined
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%. Which of the following should not receive live vaccines:
aH #atients suering ro$ hay ever
bH )dults receiving at least :0$g o prednisolone per day or $ore
than one +eek
cH #atients +ho inished i$$unosuppressive t+o years ago, ollo+ing
a bone $arro+ transplant
dH #atients receiving aJothioprine
eH #atients +ith iskott%)ldrich syndro$e
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'hapter /$$unisation o those +ith
underlying $edical conditions
1. or those aout to start immunosuppressive treatments:
aH /nactivated vaccines should be ad$inistered at least t+o +eeks
beore treat$ent starts
bH /nactivated vaccines should never be ad$inistered ater the start o
treat$ent
cH Their close contacts should be considered or vaccination against
varicella and inluenJa
dH ive vaccines should not be given to such patients +ithoutspecialist advice
eH Those +ho receive bone $arro+ transplants should be
considered or re%i$$unisation post treat$ent
2. ,hose who have no spleen or splenic dysfunction should have:
aH "ib;&en ' vaccine
bH &en B vaccine
cH &eningococcal )'L conEugate vaccine
dH #neu$ococcal vaccine
eH Iaricella vaccine
!. - patient aged seven is up to date with their vaccinations. ,hey lose
their spleen after an accident. ,hey need the following vaccines:
aH Iaricella vaccine
bH 6ingle dose o #'I 13
cH "ib;&en ' booster, ##I 23 and &en B vaccines ollo+ed by a
second dose o &en B and &en )'L one $onth later
dH "ib;&en ' booster, ##I 23 and &en B vaccines ollo+ed by a
second dose o &en B and &en )'L t+o $onths later
eH )dditional dose o &&4 vaccine
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". /remature infants should receive their first dose of the primary
immunisation:
aH T+o $onths ro$ the actual date o delivery
bH T+o $onths ro$ the esti$ated date o delivery
cH Only +hen they +eigh at least 1.5kg
dH Only once they have been discharged ro$ hospital
eH ?one o the above
%. Influen3a vaccine is specifically indicated in individuals with:
aH iabetes
bH 'ochlear i$plants
cH 'o$ple$ent disorders
dH "ae$ophiliaeH 'hronic kidney conditions including hae$odialysisH
&. - child with splenic dysfunction first diagnosed at nine months will
require:
aH /nluenJa vaccine
bH T+o doses o &en B vaccine at least t+o $onths apart
cH )n additional dose o &en B vaccine at aged t+o
dH "epatitis B vaccineeH T+o doses o &en )'L vaccine at least one $onth apart
4. Immunosuppressed patients can e protected against some
infections y administration of immunogloulin post e5posure to:
aH 'hicken po!
bH iphtheria
cH 4ubella
dH &easleseH /nluenJa
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'hapter 8 Iaccine saety and adverse
events ollo+ing i$$unisation
1. 'igns of anaphyla5is include:
aH )ngioede$a
bH Tachycardia
cH heeJe
dH "ypertension
eH Urticaria
2. - further dose of the same vaccine should not e given if the patientdevelops:
aH #ain, s+elling or redness o the site
bH /rritability
cH "eadache
dH 'ardiovascular collapse and other anaphylactic reactions
eH Te$perature above 3.5o'
!. In the case of anaphylactic reaction to a vaccine in a communityclinic you should:
aH 6eek additional health proessional assistance
bH )sk a responsible person to dial AAA and state that there is a
suspected anaphyla!is
cH 6tay +ith the patient all the ti$e
dH &anage the patient entirely in the clinic, i they appear to $ake a
ull recover
eH 6end the patient to a nearest hospital
". In a suspected anaphylactic reaction adrenaline (epinephrine)
1:1666 should e given:
aH /ntrader$ally
bH 6ubcutaneously
cH /ntra$uscularly /&H
dH /ntravenously /IH
eH )ny o the above
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%. In case of anaphyla5is half of the usual adrenaline dose should e
given to those ta7ing:
aH Beta blockers
bH Tricyclic antidepressants
cH &onoa$ine o!idase inhibitors
dH 'ocaine
eH )ll o the above
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'hapter A 6urveillance and
$onitoring or vaccine saety
1. If a vaccine carries the lac7 ,riangle symol this indicates:
aH /t is a vaccine +hich $ust be ad$inistered under hospital
supervision
bH The vaccine is not yet licensed in the U@
cH )ll suspected reactions serious and non%serious $ust be
reportedH
dH The vaccine can only be used on a na$ed%patient basis
eH Only reactions in children need to be reported
2. ,he 8ellow ard 'cheme:
aH 4eports sub$itted to the Lello+ 'ard 6che$e are entered on a
database operated by the "ealth and 6aety !ecutive "6H
bH /s not applicable to vaccines given Black Triangle status
cH )llo+s patients to report suspected adverse reactions
dH Only serious adverse reactions should be reported or vaccines
that have been $arketed or si! $onths or $ore
eH /s a co$pulsory reporting syste$ or suspected adverse reactions
!. - defect in a vaccine product should e reported:
aH Using the Lello+ 'ard 6che$e
bH Using the Black Triangle 6che$e
cH To a report centre o the &edicines and "ealthcare products
4egulatory )gency &"4)H
dH Only to the vaccine $anuacturer
eH Only i it has caused an adverse reaction in a patient
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'hapter 10 Iaccine a$age
#ay$ent 6che$e
1. ,he +accine amage /ayment 'cheme:
aH #rovides a single ta! ree pay$ent to successul clai$ants
bH /s provided to people;a$ilies o so$eone suering severe $ental
disable$ent as a result o i$$unisation against speciied diseases
cH oes not cover severely disabled children born to $others
vaccinated against speciied diseases in pregnancy
dH oes not cover severe disable$ent in a person in close contact
+ith so$eone i$$unised +ith oral polio vaccineeH /s provided to people;a$ilies o so$eone suering severe physical
disable$ent as a result o i$$unisation against speciied diseases
2. +accines covered y the +accine /ayment amages 'cheme
include:
aH iphtheria
bH "epatitis )
cH 4ubella
dH "epatitis B
eH Lello+ ever
!. +accines covered y the +accine /ayment amages 'cheme
include:
aH Typhoid
bH &easles
cH Tick%borne encephalitis
dH Haemophilus influenzae type BeH /nluenJa
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". +accines covered y the +accine /ayment amages 'cheme
include:
aH Kapanese ncephalitis vaccine
bH "#I vaccine
cH 'holera vaccine
dH #ertussis
eH B'G vaccine
%. ,o e successful claims must meet the following criteria:
aH The disabled person can be o any age
bH The disabled person can have been vaccinated in any country in
the uropean Union
cH The disabled person $ust have been i$$unised beore their 18th
birthday i the clai$ is or polio vaccinedH / the disabled person is deceased the clai$ $ust be $ade beore
they +ould have reached their 21st
birthday
eH 'lai$ant $ust have been assessed by a doctor
&. ,o e successful claims must meet the following criteria:
aH 'lai$s $ust be $ade on or beore the disabled personDs 21st
birthdaybH isability is assessed using a percentage disability test si$ilar to
that used or assessing industrial inEuries
cH The disabled person can have been i$$unised at any age against a
speciied disease, provided this +as undertaken during an outbreak in
the U@ or /sle o &an
dH )ny i$$unisations given by "& )r$ed Forces should be clearly
identiied, as these are e!cluded ro$ the sche$e
eH 'lai$s $ust be $ade +ithin si! years o the date o vaccination, or
beore the disabled person*s 19thbirthday, +hichever is the later
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4. 9nder the claims procedure:
aH )ll decisions are $ade by the 6ecretary o 6tate or ork Q
#ensions
bH )n assess$ent is $ade on the balance o probability that disability
is the result o i$$unisation +ith the percentage level o
disable$ent attributable
cH There is no appeal
dH The independent Iaccine a$age Tribunal decision is inal
eH ) re-uest or the reversal o the clai$ decision can be $ade in
+riting providing an e!planation o +hy it is believed the decision
given is +rong
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'hapter 11 /$$unisation 6chedule
1. In the 9 immunisation programme all children should e protected
against:
aH iphtheria
bH #ertussis
cH #olio
dH &easles
eH "epatitis B
2. ,he comined vaccine given at two three and four months of age
is:
aH Ta#;/#I;"ib
bH Ta#;/#I;#'I
cH Ta#;/#I;&en'
dH T#;/#I;"ib
eH Ta#;/#I;##I
!. y 1" months of age all children should have received:
aH Three doses o Ta#;/#I;"ib
bH Three doses o #'I
cH T+o doses o &en' and one o "ib;&en'
dH T+o doses o &&4
eH Three doses o 4otavirus vaccine
". - child aged two years has $ust $oined your practice. +accination
was egun aroad ut the parents are vague aout what was
given and there is no documentation. Which of the following would
you give to the child:
aH Three doses o Ta#;/#I;"ib
bH T+o doses o &en'
cH T+o doses o #'I
dH One dose o &&4
eH One dose o "ib;&en'
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%. ,he numer of doses of diphtheria# tetanus and polio vaccines
required to ensure long;term protect throughout adulthood is:
aH Three
bH Four
cH Five
dH 6i!
eH ?one o the above
&. Which of the following is#are true:
aH ) child co$ing to the U@ +ho has had a ourth dose o a
diphtheria;tetanus;pertussis containing vaccine at 18 $onths +ill
not need a pre%school booster
bH The school leaver booster contains the higher dose o diphtheriato!oid H
cH / any course o i$$unisation is interrupted, there is no need to
start the course again
dH 'hildren should receive t+o doses o conEugated pneu$ococcal
vaccine #'IH in the irst year o lie
eH #re$ature babies are at increased risk o adverse reactions ro$
vaccines
4. -t around 1" years of age children should receive:
aH &en ' conEugate vaccine
bH Ta#
cH T;/#I
dH Td;/#I
eH Td
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=. ,he following is#are true aout vaccination in pregnancy:
aH /nactivated inluenJa vaccines are preerred to live attenuated
vaccine in pregnancy
bH /nluenJa vaccine should be oered to pregnant +o$en ater the
second tri$ester
cH ) te$porary progra$$e or the vaccination o pregnant +o$en
against pertussis +as introduced in October 2012
dH /nluenJa vaccine should not be given at the sa$e ti$e as pertussis
vaccine as it $ight aected response to that vaccine
eH Iaccination o pregnant +o$en +ill provide active i$$unity
against inluenJa in the irst e+ $onths o lie in the baby
16.,he following is#are true aout the 9 routine schedule:
aH "#I vaccine is oered to girls and boys aged 12 to 1:
bH Fro$ 6epte$ber 201: the "#I schedule +ill consist o t+o doses
o vaccine at least three $onths apart
cH T+o doses o oral rotavirus vaccine are given at t+o $onths and
three $onths
dH The irst dose o pri$ary i$$unisations can be given ro$ si!
+eeks o age i re-uired in certain circu$stances
eH 4otavirus vaccine should not be started later than ten +eeks o
age
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'hapter 13 )nthra!
1. Which of the following is#are true aout anthra5:
aH /t is spread by spores o the anaerobic bacillus Bacillus anthracis
bH "as an incubation period o t+o to seven days
cH 'an cause cutaneous, inhalational and gastrointestinal inections
dH The treat$ent o choice is erythro$ycin
eH "u$an cases re-uire isolation to control spread
2. Which of the following may e considered for anthra5 vaccine:
aH Te!tile +orkers +orking +ith goat hairbH Ieterinary surgeons
cH "ousehold contacts o a hu$an case o anthra!
dH Bone$eal +orkers
eH "ealth 'are sta +orking on an /nectious iseases Unit
!. Which of the following is#are true aout anthra5 vaccine:
aH /t is a live attenuated vaccine
bH The vaccine course consists o three doses given at three +eekintervals
cH /t can be given to pregnant +o$en
dH /t is ad$inistered by intra$uscular inEection
eH ) reinorcing dose should be given every three years to those at
continued risk
". -nthra5:
aH /s a notiiable diseasebH #ri$arily aects carnivorous ani$als
cH /s a co$$on ani$al disease in estern urope
dH /s atal in around 20R o cases
eH /s al$ost an entirely occupational disease in the U@
%. -dverse reactions to anthra5 vaccine can include:
aH 6+elling at the inEection site
bH UrticariacH 4egional ly$phadenopathy
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dH Generally a higher risk o a reaction ater subse-uent doses i
there +as a reaction to the irst dose
eH 'utaneous anthra! at the inEection site in a very s$all nu$ber o
cases
&. Which of the following is#are true:
aH /$$unoglobulins are eective i given as post e!posure
prophyla!is to anthra!
bH )nthra! vaccine should not be given at the sa$e ti$e as live
vaccines
cH ) person +ho has had a severe local reaction to the irst dose o
anthra! vaccine should not receive a second dose
dH #atients +ith "/I inection and a very lo+ ': count should notreceive anthra! vaccine
eH )nthra! vaccine contains an alu$iniu$ adEuvant and thio$ersal
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'hapter 1: 'holera
1. Which of the following statements is#are true regarding cholera
vaccines availale in the 9:
aH There are t+o vaccines available one or oral and one or
intra$uscular ad$inistration
bH The oral vaccine is a live vaccine.
cH The oral vaccine protects against our strains o V. choleraeO1
dH The oral vaccine contains reco$binant B to!ins
eH The oral vaccine is thio$ersal ree
2. holera vaccines:
aH 6hould be stored in their original packaging
bH 'an be used or post e!posure prophyla!is
cH 6hould be protected ro$ light in storage
dH 'an be used saely ater reeJing
eH 'an be stored at roo$ te$perature
!. ?ral cholera vaccine should e administered to anyone over the
age of si5 years as follows
aH First dose is given +ith ood
bH 6econd dose is given bet+een one and si! +eeks ater the irst
dose
cH /t is necessary to use the sodiu$ hydrogen carbonate buer po+er
+hen preparing the vaccine or ad$inistration
dH ?o other vaccines should be given at the sa$e ti$e as the cholera
vaccine
eH 'an be stored at roo$ te$perature
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". ?ral cholera vaccine should e administered to anyone over the
age of si5 years as follows
aH The buer sachet should be $i!ed +ith 150 $l o cold +ater in a
disposable plastic cup
bH Iaccinees should avoid ood, drink and oral $edicines or an hour
beore to an hour ater ad$inistration
cH The vaccine solution +hen $i!ed +ith the buer solution can be
kept or eight hours beore drinking
dH The second dose should be ad$inistered at least a +eek beore
potential e!posure
eH / $ore than t+o years have elapsed since the last cholera
vaccination the pri$ary course $ust be repeated
%. Which of the following is#are true aout oral cholera vaccine:
aH The vaccine is reco$$ended or use in children under the age o
t+o years
bH There is data suggesting a e!cellent protective eicacy proile ater
booster doses
cH The vaccine +hen constituted should be a blue li-uid
dH The vaccine is not reco$$ended or prevention o travellers
diarrhoea
eH /$$unisation does not protect against V Cholerae serogroup 0139
&. ?ral cholera vaccine is considered for the following:
aH 4elie and disaster aid +orkers
bH )nyone visiting an area +here a cholera epide$ic is occurring
cH 6e+age +orkers in the U@
dH ?urses +orking on an inectious diseases unit in the U@
eH #eople +ith a past history o travellerDs diarrhoea
4. holera vaccine should not e given to the following:
aH 6everely i$$unoco$pro$ised individuals
bH )nyone +ho is acutely un+ell
cH #regnant and breast%eeding +o$en
dH )nyone +ho is "/I positive
eH Those +ith pre%e!isting gastro%intestinal disorders
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'hapter 15 iphtheria
1. Which of the following is#are true aout iphtheria:
aH Corynebacterium diphtheriae is the only bacteriu$ causing
diphtheria
bH Those carrying C diphtheriaeare al+ays ill
cH iphtheria to!in aects the heart, nerves and adrenal tissues
dH /nected people $ay be inectious or up to our +eeks i untreated
eH Corynebacterium diphtheriae $ay cause skin inections
2. In the 9:
aH )bout hal o adults over 30 years are susceptible to diphtheria
bH iphtheria vaccine +as introduced in the 1A50s
cH )n increase in notiications o diphtheria has been caused by a
rise in nu$bers o isolations o non%to!igenic strains o
C diphtheriae
dH &ost cases o diphtheria are i$ported
eH 6econdary cases o diphtheria are rare
!. Which of the following is#are true aout iphtheria vaccines:
aH They are live attenuated vaccines
bH They are produced in t+o strengths
cH They contain an adEuvant to i$prove i$$unogenicity
dH "igher dose diphtheria vaccines should be used or pri$ary
i$$unisation in the U@ schedule in those under ten years
eH iphtheria vaccine is thio$ersal ree
". Which of the following is#are true aout iphtheria vaccine:
aH /t is only available in co$bination +ith other vaccines
bH hen given as a pri$ary i$$unisation course t+o +eeks should be
allo+ed bet+een vaccinations
cH The irst booster dose o diphtheria vaccine should be given at
least 12 $onths ater the last in the pri$ary course
dH There should be three years bet+een the irst and second booster
doses
eH / it has been given as part o a vaccination ollo+ing a tetanus
prone +ound the routine booster is al+ays necessary
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%. - 1" year old child who is up;to;date with their vaccine schedule
stepped on a rusty nail at a riding school in rance a year ago and
was given a vaccination aroad following the in$ury. ,here is no
written record of what was given although the parents elieve this
was tetanus vaccine. ,he child has now presented for a school
leaving ooster. Which of the following is#are true:
aH The booster is not necessary
bH The risk o side eects ro$ another tetanus vaccination so soon
ater the last one is such that Td;/#I should not be given
cH The vaccination given at the ti$e o inEury should be discounted
and Td;/#I given no+
dH The child should have a urther tetanus vaccination in ten years
ti$e
eH The child should be tested or tetanus antibodies beore any
urther doses o tetanus vaccine
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'hapter 19 "ae$ophilus inluenJa
type b "ibH
1. Which of the following statements is#are true aout @i vaccine:
aH &ade ro$ capsular polysaccharide that has been e!tracted ro$
cultures o "ib bacteria
bH "as been conEugated +ith either non%to!ic variant o diphtheria
vaccine or tetanus to!oid
cH /s available as Ta#;/#I;"ib or "ib;#'I
dH /s thio$ersal%ree
eH 'ontains live organis$s
2. Which of the following is#are true aout @i#Men vaccine:
aH 'an be given at the sa$e ti$e as other vaccine such as &&4
and "ep B
bH 'an also be given routinely at the sa$e ti$e as the booster o
pneu$ococcal conEugate vaccine #'IH
cH /s better given subcutaneously to reduce risk o local reaction
dH 6hould be given at least 2.5c$ apart ro$ other vaccines given in
the sa$e li$b at the sa$e session
eH ?one o the above
!. Which of the following is#are true:
aH 'hildren under the age o ten +ith asplenia or splenic dysunction
should co$plete the pri$ary i$$unisation schedule
bH Those aged ten years and over, +ith asplenia or splenic
dysunction should receive t+o doses o co$bined "ib;&en '
vaccine t+o $onths apart i uni$$unised
cH Those ully i$$unised +ith "ib +ho then develop splenic
dysunction, need no urther doses o "ib containing vaccine
dH "ib vaccine should not be given to a person +ith a conir$ed
anaphylactic reaction to a previous dose o "ib%containing vaccine or
co$ponent o the vaccine
eH ?one o the above
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". @i vaccine should e deferred in the following situations:
aH #regnancy and breast%eeding +o$en
bH #re$ature inants
cH /$$unosuppressed people or those +ith "/I inection
dH Those +ith stable pre%e!isting neurological conditions
eH Those +ith evidence o evolving neurological deterioration
%. Which of the following should close contacts of a case of
@i infection e given:
aH / they have never had any i$$unisation and are under ten years
old three doses o Ta#;/#I;"ib vaccine
bH / bet+een one and ten years o age and have never received
"ib vaccine but have been vaccinated against diphtheria,tetanus, pertussis and polio, three doses o "ib;&en '
cH / aged bet+een one and ten years and have never been
vaccinated against diphtheria, tetanus, pertussis and polio, one
dose o "ib;&en'
dH #rophyla!is +ith isoniaJid to the inde! case, and all household
contacts, +here there is any individual in the household +ho is
also *at risk*
eH )ntibody tests to check i they are i$$une
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'hapter 1 "epatitis )
1. Which of the following is#are true aout @epatitis - vaccine:
aH The vaccine $ay cause $ild Eaundice t+o to si! +eeks ater
ad$inistration
bH /t can be given to pregnant +o$en +hen clinically indicated
cH "epatitis ) antibody levels should be tested to check or a
response
dH /s only eective i given to unvaccinated contacts o "epatitis )
+ithin 2 hours o the onset o Eaundice in the inde! case
eH 6hould not be given to so$eone +ho $ay already be incubating
"epatitis ) inection
2. Which of the following is#are true:
aH )ll available $onovalent "epatitis ) vaccines are licensed or
patients aged 12 years and above
bH There are paediatric "epatitis ) vaccines available +hich contain
higher doses o antigen than the adult preparations
cH ) booster dose o "epatitis ) vaccine should be given 9 to12
$onths ater the irst
dH / the "epatitis ) booster dose is delayed the course should be
restarted
eH ) booster dose at ten years is indicated or those at ongoing risk
!. @epatitis - vaccine is routinely recommended for the following
groups:
aH Food handlers +orking in a shellish $arket
bH /ndividuals going to reside in 6pain
cH 6e+age +orkers
dH #atients +ith chronic renal disease
eH /nEecting drug users
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". @uman Aormal Immunogloulin (@AI0):
aH hen being used as post%e!posure prophyla!is or "epatitis ) $ay
protect against disease i given +ithin 1: days o e!posure
bH ive vaccines e!cept yello+ ever vaccineH should preerably not be
given or three $onths ater ad$inistration o "?/G
cH 'an provide protection lasting up to t+o to three years
dH 6hould not be given to those +ith an allergy to eggs
eH The dose o "?/G or a child aged ive years is 250 $g
%. Which of the following @epatitis - vaccine products is#are availale:
aH 'o$bined "epatitis ) and B vaccine
bH 'o$bined "epatitis ) and ' vaccine
cH &onovalent "epatitis ) vaccine
dH 'o$bined "epatitis ) and typhoid vaccine
eH 'o$bined "epatitis ) and cholera vaccine
&. Which of the following is#are true:
aH "?/G is routinely reco$$ended or travel prophyla!is or "epatitis
)
bH "?/G is usually ad$inistered subcutaneously
cH / "?/G is given live vaccines should preerably not be given or
three +eeks
dH "epatitis ) vaccine should preerably be ad$inistered at least t+o
+eeks beore travel departure
eH )ter a dose o $onovalent "epatitis vaccine "epatitis ) antibodies
are generally detectable in all individuals at seven days using current
assays
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'hapter 18 "epatitis B
1. Which of the following statements is#are true regarding @epatitis
infection:
aH /nection results in Eaundice in greater that 50R o all cases
bH The incubation period ranges ro$ 1: to 90 days
cH 'hronic disease is strongly linked to the develop$ent o liver
cancer
dH ess that hal o children inected per%natally develop chronic
disease
eH &ost o those inected as adults +ill beco$e chronic carriers o
"BI
2. @epatitis vaccines:
aH )re not eective in patients +ith acute hepatitis B
bH )re live attenuated vaccines
cH Fe+er than 10R o adults ail to respond to a course o three
doses
dH )re very eective i used or post%e!posure prophyla!is
eH ork best in those aged over :0 years
!. @epatitis vaccines:
aH )re interchangeable dierent vaccines can be used to co$plete a
pri$ary courseH
bH )ll contain the sa$e dosage
cH 6hould not be given to a person +ho $ay already have been
e!posed to "epatitis B +ithout checking or $arkers o past
inection
dH 6hould not be ad$inistered into the buttock
eH T+o doses o adult strength vaccine are suicient or children aged
11%15 years, given at nought and si! $onths
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". Which of the following people should receive pre;e5posure @epatitis
vaccine:
aH "ealthcare +orkers including students;traineesH +orking in the U@
bH 6ta +orking in residential acco$$odation or people +ith learning
diiculties
cH $bal$ers
dH #rison oicers
eH aboratory sta handling $aterials +hich $ay contain the virus
%. Which of the following should receive pre;e5posure @epatitis
vaccine:
aH Fa$ilies adopting children ro$ high risk areas
bH 6e+age +orkerscH #eople receiving regular blood transusions
dH #eople +ith chronic liver disease
eH #eople +ith chronic renal disease
&. Which of the following should receive pre;e5posure @epatitis
vaccine:
aH #eople living in residential acco$$odation +ith learning
disabilitiesbH #rison in$ates
cH /ntra%venous drug users
dH Foster parents
eH #eople +ho +ork +ith pri$ates
4. @epatitis post;e5posure prophyla5is is recommended for:
aH #eople +ho have an accidental needlestick inEury
bH #eople +ho have had unprotected se!ual intercourse +ith a case oacute o hepatitis B seen +ithin one $onth o last contact
cH Babies born to +o$en +ith chronic hepatitis B inection
dH #eople +ho have had unprotected se!ual intercourse +ith a
recently diagnosed case o chronic hepatitis B
eH Babies born to +o$en +ho have developed acute hepatitis B
inection during pregnancy
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'hapter 18a "u$an #apillo$avirus
1. ,he following is#are true aout @uman /apillomavirus (@/+)
infection:
aH "#I 18 is responsible or $ore than 50R o all cervical cancers in
urope
bH "#I types 9 and 11 cause the $aEority o genital +arts
cH A0 R o ne+ "#I inections clear +ithin t+o years
dH )ppro!i$ately 100 types o "#I inect the genital tract
eH "#I can be trans$itted ro$ $other to ne+born baby
2. ,he following is#are true aout @/+ vaccines:
aH They are contraindicated in yeast allergy
bH For planning purposes a vaccination schedule o nought and 12
$onths is appropriate or both vaccines or girls aged A to 15 years
cH They are given intra$uscularly
dH /ndividuals +ith i$$unosuppression or +ith "/I inection should
not receive "#I vaccine
eH / a course o "#I inection is interrupted it should be repeated
!. ,he following is#are true aout 0ardasil:
aH /t contains thio$ersal
bH /t contains "#I types 9,11,19 and 18
cH The second dose o 0.5 $l should be given at least t+o $onths
ater the irst
dH There is evidence on the interchangeability o Gardasil and
'ervari!
eH /t can be given at the sa$e ti$e as Td;/#I and &&4 vaccines but
not "epatitis B vaccine
". ,he following is#are true aout ervari5:
aH /t +ill provide protection against genital +arts
bH There is no longer a supply o 'ervari! available in the U@
cH /t is supplied as a suspension o virus%like particles I#sH in a
pre%illed syringe
dH The risk o local reactions is less i given intra$uscularly rather
than subcutaneously
eH /t contains "#I types 11 and 19
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%. Which of the following is#are true aout the scheduling of
@/+ vaccines:
aH The "#I vaccine being routinely oered in the U@ since
6epte$ber 2012 is Gardasil
bH / an individual has started a course o 'ervari! then the course
can be co$pleted +ith Gardasil
cH Oering a ull course o Gardasil ollo+ing a partial or co$plete
course o 'ervari! is inadvisable
dH ) vaccination schedule o nought, one and our to si! $onths is
appropriate or both vaccines or girls co$$encing vaccine at age
15 years and above
eH / an "#I vaccine course is interrupted it should be resu$ed
rather than be repeated
&. In the 9 the groups recommended to receive @/+ vaccine
include(s):
aH Fe$ales aged A to 11 years
bH &ales aged 12 to 13 years
cH Fe$ales aged 11 to under 18 years
dH Fe$ales aged 18 or over +ho have not already started a course
o "#I vaccine
eH Fe$ales aged 18 or over +ho started the "#I course +hen they+ere under 18 years
4. In the 9 programme the following patient groups should not e
routinely advised to receive @/+ vaccine:
aH #atients +ith i$$unosuppression
bH #atients +ith "/I inection
cH #atients +ho are pregnant
dH &ales aged 11 to 18 years
eH Fe$ales co$ing to the U@ ro$ overseas under the age o 18
years +ith an uncertain i$$unisation history
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'hapter 1A /nluenJa
1. Which of the following is#are true:
aH /nluenJa is caused by type ), B or ' viruses
bH /nluenJa ) is the usual cause o epide$ics
cH &inor changes in the surace antigens o inluenJa ) occur every
year
dH C)ntigenic shitD $eans a $aEor change in the inluenJa ) virus has
occurred
eH The burden o inluenJa B disease is $ostly in adults
2. Which of the following is#are true aout Influen3a vaccines:
aH They $ust be given annually
bH &ost current vaccines have t+o inluenJa ) subtypes and one B
subtype in the$
cH ) -uadrivalent vaccine +ith an additional inluenJa ) virus has
been developed
dH &ost o the vaccines are prepared ro$ viruses gro+n in
e$bryonated hens eggs
eH They $ay cause inluenJa in so$e individuals
!. Influen3a vaccine should e offered to the following:
aH The $ain carer o a disabled person
bH 4esidential care ho$e sta
cH )ll the in$ates o a young oenders institution
dH ) pregnant +o$an
eH ) $id+ie
". /atients with the following conditions should have
seasonal influen3a vaccine:
aH Type 1 diabetes
bH 6tage 2 chronic renal disease
cH iabetes controlled by diet
dH 'ystic Fibrosis
eH 6evere learning disability
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%. ,he following is#are true aout flu vaccine in pregnancy:
aH /nluenJa vaccine is contraindicated in the irst tri$ester o
pregnancy
bH /nluenJa vaccine should be oered ro$ the third tri$ester o
pregnancy
cH #regnant +o$en are $ore likely to suer side aects ro$ the
vaccine
dH #regnant +o$en +ho have received inluenJa vaccine are at
slightly increase risk o $iscarriage
eH /nluenJa vaccine given to the $other $ay provide passive
i$$unity to the inant in the irst e+ $onths o lie
&. ontraindications to Influen3a vaccination include:
aH 'onir$ed anaphylactic reaction to a previous dose o inluenJa
vaccine
bH 'onir$ed anaphylactic reaction to egg products
cH ) rash ollo+ing a previous vaccination
dH #regnancy
eH )ged less than t+o years
4. -dverse reactions to inactivated flu vaccine may include:
aH #ain and s+elling at the inEection site
bH "igh grade ever
cH &yalgia
dH 6hivering
eH 'linical inluenJa
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=. ,he following is#are true aout luen3B:
aH /t contains live attenuated virus
bH /t is reco$$ended or children +ith egg allergy
cH /t is contraindicated in patients receiving inhaled corticosteroids
dH / inluenJa vaccine has not been received previously a three year
old child having FluenJBshould receive t+o doses
eH 'an be ad$inistered by health care +orkers +ho are pregnant
16.,he following is#are true:
aH FluenJBis authorised or children aged t+o to under ten years
bH /ntanJaBis an inactivated intrader$al vaccine
cH /nactivated intra$uscular vaccine can be given ro$ si! $onths o
age
dH #regnant +o$en should be oered FluenJB
eH OptaluBis the only available albu$in ree inluenJa vaccine
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'hapter 20 Kapanese encephalitis
KH
1. Capanese encephalitis:
aH /s a tick borne viral encephalitis
bH "ighest trans$ission rates occur during and Eust ater dry seasons
cH "as an incubation period o 5 to 15 days
dH /s associated +ith a rate o appro!i$ately 10R o neurological
se-uelae in survivors
eH /s not trans$itted ro$ person to person
2. CD vaccine should:
aH Be given to those +ho are going to an ende$ic or epide$ic area
bH Be given to laboratory sta +ho have potential e!posure to the
virus
cH ?ot be given to those +ho have had a conir$ed anaphylactic or
serious syste$ic reaction to a previous dose o K vaccine
dH ?ot be given to those +ho have had a conir$ed anaphylactic
reaction to any co$ponent o the vaccine
eH ?ot be given during pregnancy and breast%eeding
!. Which of the following is true aout CD vaccines:
aH They contain no live organis$s
bH They should be given by subcutaneous inEection
cH Both U@%//)4O and Green 'ross vaccines are licensed in the U@
dH They can be given at the sa$e ti$e as other travel or routine
vaccines
eH They are not usually reco$$ended in children under one year o
age
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". Which of the following is#are true:
aH The reco$$ended vaccine or adults aged 18 years and over is
//)4O
bH For children aged one year to 39 $onths o age the reco$$ended
vaccine schedule is 2 ! 0.5 $l doses o Green 'ross vaccine on
days nought and 28 to 30
cH The reco$$ended pri$ary schedule or //)4O co$prises three
doses
dH Green 'ross vaccine has not been associated +ith adverse
outco$es in pregnancy
eH //)4O and Green 'ross vaccines are interchangeable during a
course o vaccination
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'hapter 21 &easles
1. >ecognised complications of infection with measles virus include:
aH Otitis $edia
bH 'onvulsions
cH #neu$onia
dH 'onstipation
eH Koint pains
2. 'u;acute sclerosing pan;encephalitis (''/D):
aH /s a atal late co$plication o $easles inectionbH Occurs in every 25,000 $easles inections
cH "as increased in rate since the introduction o &&4 vaccine
dH The risk o developing 66# is greater i the child has $easles
inection ater the age o one year
eH &ay take 20 to 30 years to develop post $easles inection
!. If a child has received a dose of MM> vaccine efore the age of 12
months:
aH They need only one urther dose o &&4 given at the sa$e ti$e as
the pre%school booster i$$unisations
bH The child needs to receive t+o urther doses o &&4 vaccine given
at 12 to 13 $onths and at the sa$e ti$e as the pre%school boosters
cH The response to a dose given beore 12 $onths $ay be subopti$al
due to persistence o $aternal antibodies in the baby
dH This $ay increase the risk o an adverse reaction to any
subse-uent dose
eH /t is +orth checking or $easles antibodies beore deciding to
give a urther dose
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". Which of the following is#are true aout MM> vaccine:
aH /t is a live attenuated vaccine
bH /t should not be given to children +ith autis$
cH /t should not be given in pregnancy
dH /t is better not to give it i a person has a previous history o either
$easles, $u$ps or rubella
eH / the vaccine course is started ater the age o 18 $onths a child
needs t+o doses separated by three $onths
%. Which of the following is#are true:
aH ) single dose o &&4 vaccine coners protection against $easles in
about 80R o individuals
bH There is a link bet+een Guillain%Barr syndro$e GB6H and &&4
vaccine
cH ) $ild $easles%like rash $ay develop three +eeks ater &&4
vaccine
dH )llergy to egg is not an absolute contra%indication to &&4
eH There is no evidence o $easles vaccine virus being ound in
breast $ilk
&. Which of the following is#are true aout managing contacts of
measles:
aH )dvice should be sought ro$ the local "#U or $icrobiologist
bH "?/G $ay be indicated in non%i$$une contacts +ho are pregnant,
i$$unoco$pro$ised or under nine $onths o age
cH /n susceptible i$$unoco$petent contacts in +ho$ &&4 is not
contra%indicated a dose o &&4 $ay protect the$ i given +ithin
three days o e!posure
dH here "?/G is given, an interval o at least three $onths $ust be
allo+ed beore subse-uent &&4 i$$unisationeH &easles inection in pregnancy can lead to congenital
$alor$ation
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'hapter 22 &eningococcal
1. - diagnosis of meningococcal infection requires the following to e
present:
aH "eadache
bH ?eck stiness
cH #hotophobia
dH ro+siness
eH #yre!ia
2. Meningococcal infection in young infants:
aH 4arely presents +ith an insidious onset
bH ill usually present +ith the classical signs o $eningitis
cH 6hould be considered i the child has a raised anterior ontanelle, i
still patent
dH /s likely to be present in an apyre!ial child
eH 6hould be considered +here a child is irritable
!. Meningococci:
aH )re $ost oten har$less co$$ensals colonising the nasopharyn!
bH )re carried by about a -uarter o adolescents, +ho sho+ no signs o
disease
cH )re trans$itted by aerosol
dH )re usually trans$itted +ith $ini$al contact
eH 'ause inection $ost re-uently in teenagers
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". Meningococcal con$ugate (Men) vaccine:
aH as introduced to the U@ routine i$$unisation progra$$e in
1AAA
bH The irst dose is given in the U@ pri$ary vaccination schedule to
children at three $onths
cH 6hould be oered as a single dose to anyone over the age o ten
years +ho has not co$pleted the pri$ary childhood schedule up to
the age o 50
dH /s given as a reinorcing dose as "ib;&en ' vaccine bet+een 12
and 13 $onths o age and a dose o &en ' vaccine in adolescence
in the U@ pri$ary vaccination schedule
eH 'hildren over the age o one and under the age o ten +ho have not
received any &en ' vaccine should be oered a single dose o
&en ' vaccine or "ib;&en ' vaccine
%. Which of the following is#are true aout children and adults
with asplenia and splenic dysfunction:
aH 'hildren under one year o age should receive t+o doses o &en
)'L vaccine at three and our $onths
bH 'hildren presenting over t+o years o age should be given one dose
o "ib;&en ' vaccine and one dose o &en )'L conEugate vaccine
one year latercH )dults +ho develop splenic dysunction should be oered &en B
vaccine
dH / travelling to a country at increased risk o ), 135 or L disease
children under ive should be oered &en )'L polysaccharide
vaccine
eH 'onEugate &en )'L vaccine gives a poorer response than
polysaccharide &en )'L vaccine
&. Which of the following people should receive meningococcalgroup vaccine:
aH "ousehold contacts o a case o group ' $eningococcal
$eningitis, i not previously i$$unised +ith &en' vaccine
bH ) case o group ' $eningococcal inection +ho has been
previously vaccinated against &en'
cH 'hildren +ith no docu$entary record o having received the
vaccine
dH )ll adults over the age o 25 +ith no previous docu$ented record o
receiving the vaccineeH 'ontacts o a case o viral $eningitis
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4. Meningococcal vaccines are contra;indicated in the following:
aH #regnant +o$en
bH "/I positive people
cH Other people +ith severe i$$uno%co$pro$ising conditions
dH #re$ature inants
eH Breast eeding $others
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11. ,he following is#are true aout quadrivalent -W8 vaccines for
travel:
aH /n patients over age ive conEugate &en )'L is preerred to
polysaccharide )'L vaccine
bH 'hildren under one need one dose o &enveoV
cH 'hildren aged bet+een ive and ten need t+o doses o &enveoV or
?i$enri!V
dH / an inant re-uires &en )'L conEugate vaccine at the sa$e ti$e
as routine &en ' vaccine replace the &en ' vaccine +ith
&en )'L conEugate vaccine
eH / an inant has already had &en ' vaccination then &en )'L
should also be given
12.,he following is#are true aout " Men protein vaccine
(e5seroB):
aH aH Be!seroV $ay protect up to A8R o circulating &en B strains in
ngland and ales
bH bH Be!seroV $ay also protect against inection by other capsular
groups o $eningococcus
cH cH /s currently reco$$ended or household contacts o an inde!
case o invasive group B $eningococcal disease
dH dH /s licensed or use ro$ t+o $onths o ageeH eH /s $ade ro$ one ?.$eningitidis protein
1!.,he following is#are true aout " Men protein vaccine
(e5seroB):
aH /t is supplied as a vial o +hite po+der +ith a separate diluent
bH /n the routine i$$unisation schedule is given at t+o and our
$onths +ith a booster at 12 to 13 $onths
cH /n the routine i$$unisation schedule is given at t+o, three and
our $onths
dH /t should be oered as a single dose to students attending
university or the irst ti$e
eH /s no+ routinely reco$$ended or individuals +ho are travelling
or going to reside abroad
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1".>egarding the " Men protein vaccine (e5seroB):
aH #ost vaccination ever peaks at around t+o hours and has usually
gone by 2: hours ater vaccination
bH Three doses o paraceta$ol given prophylactically at the ti$e o
vaccination then at our to si! hourly intervals reduces the ever
cH /buproen has been ound to be as eective as paraceta$ol in
reducing the ever
dH The i$$unogenicity o other routine vaccines in inants co%
ad$inistered +ith :' &en B is not aected by giving
paraceta$ol
eH Fever o W:0S' in a child ollo+ing a dose o Be!seroV is a
contraindication to the child receiving a urther dose o the vaccine
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'hapter 23 &u$ps
1. Which of the following is#are true aout mumps infection:
aH )ll patients have bilateral s+elling o the parotid glands
bH )sy$pto$atic inection does not occur
cH /t +as the co$$onest cause o viral $eningitis in children beore
1A88
dH ?eurological co$plications can occur +ithout s+elling o the
salivary glands
eH &u$ps is a co$$on cause o sub%ertility
2. Mumps vaccine:
aH /s available only in the &&4 vaccine
bH ) single dose o a $u$ps antigen containing vaccine is around
9:R eective
cH 6hould not be given i there is a history o $u$ps
dH 'an be given at any age
eH )dverse reactions to the $u$ps containing vaccines $ay occur up
to si! +eeks post vaccination
!. Which of the following is#are true aout MM> vaccines:
aH /t is eective prophyla!is i given ater e!posure to $u$ps
inection
bH ill not e!acerbate the sy$pto$s i given to so$eone +ho is
already incubating $u$ps inection
cH ) $u$ps like illness occurring t+o days later &&4 vaccine is
likely to be due to the vaccine
dH /t is better not to oer &&4 i there is uncertainty about an
individuals $u$ps vaccination status
eH 'ontact +ith suspected $u$ps inection is a good opportunity to
oer &&4 to a previously unvaccinated individual
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'hapter 2: #ertussis
1. Which of the following is#are true aout the acellular pertussis
vaccines (Infanri5 and /ediacel) used in the 9:
aH They are conEugated vaccines
bH They oer e-ual or better protection than the +holecell pertussis
vaccine
cH They are only given as part o the co$bined products
Ta#;/#I;"ibH or Ta#;/#I or dTa#;/#IH
dH They are thio$ersal%ree
eH They can be given at the sa$e ti$e as other vaccines such as
&&4, &en ' and "ep B but in a dierent siteH
2. Which of the following is#are trueE or full protection against
pertussis infants and children under ten years of age need:
aH Three doses o a pertussis vaccinecontaining product +ith an
interval o one $onth bet+een each dose and a booster ater three
years
bH Three doses o Ta#;/#I or Ta#;/#I;"ib and a booster i they
have never had pertussis vaccine, but have received three doses o
vaccine against diphtheria, tetanus and polio
cH To repeat the course i the pri$ary course is interrupted
dH Full U@ schedule should be ollo+ed i no reliable history o
previous i$$unisation is available
eH ?o urther pertussis containing vaccine i they have had a clinical
history o +hooping cough
!. Which of the following is#are trueE /ertussis vaccine should not e
given to:
aH Those +ith conir$ed anaphylactic reaction to a previous dose o a
pertussis%containing vaccine or to neo$ycin, strepto$ycin or
poly$y!in
bH #regnant +o$en
cH #re$ature inants
dH Those +ith /$$unosuppression and "/I inection
eH Those +ith stable pre%e!isting neurological condition
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'hapter 25 #neu$ococcal
1. Which of the following is#are true regarding pneumococcal
infection:
aH The $aEority o inections in adults and children are caused by up to
ten capsular seroH types
bH The incubation period is deined as seven to ten days
cH Trans$ission co$$only occurs ater transient contact +ith a case
dH /nections are at their peak in the +inter $onths
eH /n general inections are trivial but irritating
2. /neumococcal polysaccharide vaccine:
aH 'overs about A9R o the serotypes +hich cause serious inection in
the U@
bH 'overs 23 serotypes
cH /s highly eective at preventing pneu$ococcal inections,
particularly otitis $edia
dH /s eective at all ages
eH #ost i$$unisation antibodies +ane ater about ive years
!. /neumococcal con$ugate vaccine (/+):
aH /n children under 12 $onths, re-uires $ore than one dose to
produce eective protection
bH )ppears to produce Nherd i$$unity
cH 'ontains thio$ersal
dH /s available +hich covers 13 serotypes
eH "as led to a increase in invasive disease due to non%vaccine
serotypes serotype replace$entH
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". /neumococcal con$ugate vaccine (/+):
aH as introduced to the U@ in 2000
bH /n the U@ pri$ary vaccination schedule is given to children at t+o
and our $onths
cH 6hould be oered routinely as a single dose to anyone over the
age o 2 years +ho has not co$pleted the pri$ary childhood
schedule
dH /s given as a reinorcing dose bet+een 12 and 13 $onths o age in
the pri$ary U@ schedule
eH 6hould be given to any child under ive years o age +ho develops
invasive pneu$ococcal inection, irrespective o their previous
vaccination history
%. /neumococcal polysaccharide vaccine:
aH /s reco$$ended or everyone aged 95 years and over
bH "as a pri$ary schedule o t+o doses, given three $onths apart
cH Boosters should be given to all people in clinical risk groups every
ive years
dH 6hould be given to children in high%risk groups above the age o si!
$onths
eH /s reco$$ended or all patients +ith asplenia or splenic
dysunction
&. Which of the following people should receive pneumococcal
vaccines:
aH #eople +ith chronic respiratory disease
bH "ousehold contacts o a case o pneu$ococcal $eningitis
cH #eople +ho have cerebrospinal luid leaks
dH )nyone +ho has developed invasive pneu$ococcal disease and
has not been vaccinated in the pasteH )ny child under t+o years o age +ith an inco$plete vaccine
history
4. Which of the following should receive pneumococcal vaccines:
aH )t risk children over t+o years should receive a dose o ##I in
addition to their pri$ary #'I doses
bH #eople +ith chronic heart disease
cH iabetics *controlled by diet*
dH #eople +ith cochlear i$plants
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eH #eople +ith chronic renal disease
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16.Which of the following is#are recognised adverse reactions to
pneumococcal vaccines:
aH Up to one in ive recipients o #'I develops lo+ grade ever
bH 6yste$ic reactions occur -uite oten +ith both pneu$ococcal
vaccines
cH /$paired sleep is co$$on ollo+ing ##I
dH iarrhoea is co$$on in inants and toddlers ollo+ing #'I
eH #ain and induration at the vaccine site can last or three days
ollo+ing ##I
11. Which of the following is#are true:
aH )t risk children 12 $onths to ive years should also receive one
dose o polysaccharide vaccine ater the third birthdaybH here it is not practical to give pneu$ococcal vaccine at least t+o
+eeks beore splenecto$y i$$unisation should be delayed at least
t+o $onths ater the operation
cH 'hildren aged bet+een t+o to ive years +ho have been ully
i$$unised and then develop splenic dysunction should be oered
an additional dose o #'I
dH Thirteen valent #'I is routinely reco$$ended or at risk adults
eH #neu$ococcal vaccines are contra indicated in pregnant +o$en
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'hapter 29 #olio
1. Infection with polioviruses:
aH /s $ost oten asy$pto$atic
bH 'hildren are $ore likely to have inection +ithout illness than
adults
cH 'ases are $ost inectious Eust beore and up to si! +eeks post
onset o illness
dH ive vaccine strains $ay rarely cause paralytic disease
eH The last case o natural polio inection in the U@ +as in 1A5:
2. ?ral polio vaccine (?/+):
aH &ay protect contacts o vaccinated people
bH #ro$otes antibody or$ation in the gut
cH 4educes the re-uency o sy$pto$less e!cretion o +ild viruses
dH &ay cause vaccine associated paralytic polio
eH /s still used or routine vaccination in the U@
!. Inactivated polio vaccine (I/+):
aH /s $ade ro$ t+o polio virus strains
bH /s available in both intra$uscular and oral preparations
cH 6hould not be used i a vaccination course +as started +ith O#I
dH /s reco$$ended as Td;/#I or those over ten years
eH /s reco$$ended or so$e laboratory +orkers
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". - 21 year old attends your surgery for travel vaccines. @e is
ac7pac7ing around the world his itinerary uncertain ut includes
India ,hailand -ustralia and 'outh -merica. @e has had a primary
course of diphtheria tetanus and polio vaccines ut missed his
preschool and school leaving ooster vaccinations.
'o far as protection against polio is concerned:
aH "e already has suicient protection
bH "e needs Eust one dose o Td;/#I to continue his course
cH )s he had tetanus vaccine less than ten years ago the risk o a
local reaction $eans it is un+ise to give hi$ Td;/#I
dH "e should be given a dose o Td;/#I, and a urther dose o Td;/#I
in ten years ti$e
eH "e should be given O#I as he $ay be visiting countries +here
polio is still a proble$
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'hapter 2 4abies
1. Which of the following statements is#are true aout raies vaccines:
aH There are currently t+o rabies vaccines licensed or use in the U@
bH The vaccines available in the U@ are thio$ersal ree
cH The vaccines are inactivated, do not contain live organis$s and
can not cause the disease against +hich they protect
dH The vaccines should not be used interchangeably to provide
protection both pre% or post%e!posure
eH They can be stored roJen
2. Which of the following is#are trueE /re;e5posure (prophylactic)immunisation with raies vaccine should e offered to:
aH aboratory +orkers handling the virus
bH Those ,+ho in course o their +ork regularly handle i$ported
ani$als
cH Ieterinary and technical sta in the )ni$al "ealth division;F4)
dH Those living in or travelling or $ore than one $onth to rabies%
enJootic areas
eH )nyone travelling abroad
!. Which of the following is#are true aout raies vaccine:
aH #re%e!posure rabies vaccine should not be given to those +ho have
had a conir$ed anaphylactic reaction to a previous dose o rabies
vaccine
bH The intrader$al route is reco$$ended or pre%e!posure
prophyla!is
cH #regnant and breast eeding $others should only receive pre%
e!posure rabies vaccine i the risk o e!posure is high and rapid
access to post%e!posure prophyla!is is li$ited
dH There are no absolute contraindications to post%e!posure rabies
vaccine
eH The vaccine should be given to i$$unosuppressed and "/I
patients regardless o their ': count
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". - previously unimmunised individual at high;ris7 of raies requires
the following as post;e5posure prophyla5is:
aH T+o doses o rabies vaccine on days 0 and 3
bH Four doses o rabies vaccines on days 0, 3, and 1:
cH Five doses o rabies vaccine on days 0, 3 , 1: and 30
dH Five doses o rabies vaccine on days 0, 3, , 1: and 30, plus
"yper%/$$une 4abies /$$unoglobulin "4/GH on day 0
eH T+o doses o rabies vaccine on days nought and three, plus "4/G
on day nought
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'hapter 2a 4espiratory 6yncytial
Iirus
1. >espiratory 'yncytial +irus (>'+):
aH 'auses bronchiolitis in inants
bH "as an incubation period varying ro$ ive to ten days
cH "as neura$inidase and hae$agglutin surace glycoproteins in
co$$on +ith inluenJa virus
dH &ay inect individuals repeatedly +ith the sa$e strain
eH The disease severity is inluenced by the virus subtype
2. Infections with >'+:
aH 4esult in hospitalisation o 10R o inected children
bH 'o$$only peak in the spring in the U@
cH &ay cause ear inections
dH &ay increase risk o developing asth$a later in childhood
eH ill have occurred in al$ost all children at least once by the age o
t+o years
!. /alivi3uma:
aH /s a conEugated vaccine
bH Targets the F protein o 46I
cH #rovides passive i$$unisation
dH 4e-uires +eekly ad$inistration during the 46I season
eH /s indicated or high risk adults as +ell as children
". /alivi3uma:
aH /s given by /& inEection
bH 6hould not be given at the sa$e ti$e as vaccines ad$inistered as
part o the childhood i$$unisation progra$$e
cH 6hould preerably be given in the deltoid region
dH "as a reco$$ended dose o 15 $g;kg o body +eight given once a
$onth
eH uring the 46I season up to a $a!i$u$ o ten doses should be
given
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%. uring the >'+ season /alivi3uma should e considered for
the following:
aH 'hildren born at 35 +eeks or less and under one year o age at
the onset o the 46I season
bH 'hildren under t+o years o age +ith hae$odyna$ically signiicant
congenital heart disease
cH 'hildren under the age o t+o years +ith asth$a +ho are
re-uently hospitalised
dH )dults undergoing cardiac surgery at the beginning o the 46I
season
eH 'hildren under t+o years o age re-uiring treat$ent or
bronchopul$onary dysplasia in the previous si! $onths
&. hildren with the following underlying history should e considered
for treatment with /alivi3uma:
aH )splenia
bH 6evere co$bined i$$unodeiency syndro$e 6'/H
cH 4e-uiring long ter$ ventilation
dH )cyanotic chronic heart disease
eH "/I inection
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'hapter 2b % 4otavirus
1. ,he following is#are true aout rotavirus vaccines:
aH The t+o licensed rotavirus vaccines 4otari!V and 4otaTe-V are
not interchangable
bH The vaccine is A5R eective at protecting against rotavirus
inection in the irst t+o years o lie
cH /t is an inactivated vaccine
dH The vaccine is not inEectable
eH The vaccine $ay be roJen beore use
2. ,he ideal recommended schedule for >otari5B is:
aH One dose at the our $onth vaccination visit
bH T+o doses at the t+o and three $onth vaccination visits
cH T+o doses at the three and our $onth vaccination visits
dH T+o doses at 15 +eeks and 2: +eeks
eH One dose given any ti$e beore 19 +eeks
!. In line with W@? recommendations infants who have not yet
received a first dose of rotavirus vaccine should not e commencedon >otari5B if they are older than:
aH Ten +eeks
bH T+elve +eeks
cH T+enty%our +eeks
dH T+enty +eeks
eH Fiteen +eeks
". >otari5B is contraindicated in:
aH /nants under 12 +eeks o age
bH /nants +ith 6'/
cH /nants +ith ructose intolerance
dH #re$ature inants
eH /nants +ho are "/I positive
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%. Which of the following is#are true:
aH There should be an interval o a $onth bet+een a dose o
rotavirus vaccine and B'G
bH 4otavirus and B'G can be given at any ti$e beore or ater each
other
cH / the inant spits out the vaccine up to t+o replace$ent doses $ay
be given at the sa$e vaccination visit
dH The vaccine needs to be reconstituted ro$ po+der beore
ad$inistration
eH 4otari!V vaccine is supplied as an oral suspension o a cloudy
luid
&. In relation to intussusception:
aH The background risk o intussusception peaks in the U@ at 12
$onths o age
bH /ntussusception $ainly occurs ater surgery to the intestine
cH The annual incidence in the U@ is 120 cases per 100,000 children
dH 4otari!V should not be given to inants +ith a previous history o
intussusception
eH 4otari!V $ay be associated +ith a s$all risk o intussusception
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'hapter 28 4ubella
1. Which of the following is#are true aout >uella:
aH /t is caused by a herpes virus
bH The incubation period is 10 to 12 days
cH 'linical diagnosis is usually reliable
dH The inectious period is ro$ one +eek beore sy$pto$s to our
days ater the onset o rash
eH The rash is generally vesicular
2. >ecognised complications of >uella include:
aH )rthralgia
bH #arotid s+elling
cH Thro$bocytopaenia
dH Ulcerative colitis
eH #ost inectious encephalitis
!. Which of the following is#are true aout ongenital >uella'yndrome (>'):
aH /nection in the irst 8%10 +eeks o pregnancy results in da$age in
10R o surviving inants
bH Fetal da$age is rare ollo+ing inection ater 19 +eeks o
pregnancy
cH /s al+ays apparent at birth
dH "as been docu$ented in babies born to +o$en +ho have
inadvertently given &&4 vaccine in pregnancy
eH To prevent the risk o '46 in a subse-uent pregnancy +o$en +ho
are ound to be non%i$$une in pregnancy should receive &&4
vaccine ater delivery
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". Which of the following is#are true aout MM> vaccine and >uella:
aH 'hildren should not receive &&4 vaccine i their $others are in
early pregnancy
bH ) $ild rubella like rash $ay be seen t+o to three +eeks ater a
dose o &&4 vaccine
cH )rthralgia, probably due to the rubella co$ponent, is a reported
rare occurrence ater &&4.
dH /T# ollo+ing &&4 is $ore likely to be due to $easles than the
rubella co$ponent
eH 6$all a$ounts o rubella vaccine virus have been ound in breast
$ilk but this is not har$ul to the baby nor a contra%indication to
&&4 i$$unisation +hilst breast%eeding
%. Which of the following is#are true aout MM> vaccine and >uella:
aH &&4 vaccine $ay occasionally provide eective post e!posure
prophyla!is ollo+ing contact +ith rubella
bH &&4 vaccine should not be given i there is any likelihood a
person is already incubating rubella
cH Ter$ination o pregnancy should not be reco$$ended ollo+ing
inadvertent ad$inistration o &&4 to a pregnant +o$an
dH here rubella non%i$$une +o$en have received anti%
i$$unoglobulin post partu$ the dose o &&4 vaccine should bedeerred.
eH ) blood transusion around the ti$e o delivery $ay aect the
response to &&4 vaccine given post partu$
&. Which of the following is#are true:
aH The selective vaccination policy o oering single dose rubella
vaccination to teenage girls in the U@ ceased in 1AAA
bH ) single dose o rubella containing vaccine coners around 85R toA0R protection against rubella
cH 6atisactory evidence o rubella protection includes docu$entation
o a positive antibody result or rubella or having received one
dose o rubella containing vaccine or &&4.
dH "u$an nor$al i$$unoglobulin "?/GH is not reco$$ended or
post%e!posure protection against rubella
eH The diagnosis o rubella con be conir$ed non%invasively by
testing or speciic /g& in oral luid salivaH
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'hapter 28a % 6hingles
1. ,he following is#are true aout shingles:
aH The esti$ated lieti$e risk o ac-uiring shingles is about one in
our
bH /t can be ac-uired ro$ another individual +ho has chicken po!
cH The rash typically lasts bet+een t+o to our +eeks
dH Ophthal$ic Joster occurs in about :R o cases
eH /ndividuals +ith active lesions can trans$it IMI to susceptible
individuals to cause chicken po!
2. ,he following is#are true:
aH The accepted deinition o #ost "erpetic ?euralgia #"?H is pain
that persists or 90 days ater the onset o rash
bH The risk o #ost "erpetic ?euralgia #"?H decreases ater the age
o A
cH Giving Mostava! to a person +ith sy$pto$s o #ost "erpetic
?euralgia #"?H $ay oer so$e therapeutic beneit
dH N"erpes Joster ophthal$icus $ay result in glauco$a
eH &ost deaths linked to disse$ination o reactivated varicella virus
are attributable to encephalitis
!. ,he following is#are true aout Fostava5:
aH /t contains a strain o varicella Joster virus at signiicantly higher
dose than the Iariva! varicella vaccine
bH /t reduces the incidence o shingles in those aged 90 and 0 by
over 0R
cH /t can be ad$inistered si$ultaneously +ith oral antiviral agents
dH /t can be ad$inistered at the sa$e ti$e as inactivated inluenJa
vaccine
eH /t should not be ad$inistered at the sa$e ti$e as 23 valent
pneu$ococcal vaccine as it gives an inerior IMI antibody
response
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". ,he course of Fostava5 consists of:
aH ) single dose
bH T+o doses one $onth apart
cH Three doses one $onth apart
dH ) single dose +ith a booster dose one year later
eH ) single dose +ith a booster dose three years later
%. ,he administration route for Fostava5 is:
aH /ntrader$al
bH 6ubcutaneous
cH /ntra$uscular
dH /ntravascular
eH /ntranasal
&. Fostava5 should not e administered to:
aH #atients +ith a previous history o shingles over a year ago
bH #atients +ithout a previous history o chicken po!
cH #atients +ith sy$pto$s o #ost "erpetic ?euralgia #"?H
dH #atients using topical acyclovir
eH #atients +ith sy$pto$s o shingles
>eported adverse reactions to Fostava5 include:
aH "eadache
bH #ruritis
cH Fever
dH /diopathic Thro$bocytopaenic purpura /T#H
eH &yalgia
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'hapter 2A % 6$allpo!
1. Which of the following is#are true regarding smallpo5 and smallpo5
vaccination:
aH The +orld +as declared s$allpo! ree in ece$ber 1AA
bH &e$bers o s$allpo! response tea$s should be vaccinated
against s$allpo!
cH 6ta +orking in laboratories +ith $onkey po! should be
considered or vaccination against s$allpo!
dH #eople opening crypts +here s$allpo! cases $ay have been
buried should be vaccinated against s$allpo!
eH 6$allpo! vaccine can be given saely to anyone
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'hapter 30 Tetanus
1. ,he disease tetanus:
aH /s caused by the action o tetanus to!in
bH /s unlikely in unvaccinated individuals in the U@ as there is herd
i$$unity
cH 'an never be eradicated as the spores are co$$on in the
environ$ent
dH Follo+ing a national vaccination progra$$e al$ost disappeared in
adults over 95 in the U@ by the 1A0s
eH /nEecting drug use is a risk actor
2. ,etanus vaccine:
aH /s a live attenuated vaccine
bH 'ontains adEuvant
cH /s available as a single antigen vaccine in the U@
dH 6hould not given +ith &&4 vaccine
eH Five doses provide long ter$ protection
!. ,etanus containing vaccines should not e given if:
aH There has been a conir$ed anaphylactic reaction to a previous
dose o a tetanus containing vaccine
bH There has been a conir$ed anaphylactic reaction to neo$ycin,
strepto$ycin or poly$y!in B
cH There has been a severe reaction to a previous vaccination including
persistent crying or screa$ing or $ore than three hour
dH There has been a severe local reaction including s+elling o the
+hole circu$erence o the ar$
eH The intended recipient is a breast eeding +o$an
". - tetanus prone wound would include one:
aH hich re-uires surgery that is delayed or $ore than si! hours
bH hich has a lot o devitalised tissue
cH here there