mcqsgreenbookoct15_ggch (1)

7/25/2019 MCQsGreenBookOct15_GGCH (1)

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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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sse! "ealth #rotection Tea$ % &'(s on the Green Book

)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

1:


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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

1A


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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


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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31/88


'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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35/88


'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

3:


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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


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

3


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40/88


'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

3A


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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

:0


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'hapter 1A /nluenJa


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

:1


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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


44/88


=. ,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

:3


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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

:5


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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

:9


48/88


". 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


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

:


49/88


'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

:8


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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

:A


51/88


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


52/88


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


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

9:


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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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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$


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

mcqsgreenbookoct15_ggch (1)

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