Travel vaccines for children US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Travel vaccines for children. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Travel vaccines for children US Medical PG Question 1: An 18-year-old girl is brought to the emergency department because of a 1-day history of severe headache with photophobia and diffuse myalgias. She is a college student and lives in a dormitory in a large urban area. She has not traveled recently. On arrival, she is lethargic. Her temperature is 39.3°C (102.7°F), pulse is 120/min, and blood pressure is 88/58 mm Hg. Examination shows scattered petechiae and ecchymoses on the trunk and lower extremities. There is decreased range of motion of the neck. Cerebrospinal fluid analysis shows a cell count of 1,600/μL (80% neutrophils) and a lactate concentration of 5.1 mmol/L. Which of the following is most likely to have prevented this patient's condition?
- A. Intravenous vancomycin
- B. Polysaccharide conjugate vaccine (Correct Answer)
- C. Erythromycin therapy
- D. Doxycycline therapy
- E. Toxoid vaccine
Travel vaccines for children Explanation: ***Polysaccharide conjugate vaccine***
- This patient presents with symptoms highly suggestive of **bacterial meningitis** and **septic shock**, likely caused by *Neisseria meningitidis*, given the petechiae, ecchymoses, and rapid deterioration.
- A **meningococcal conjugate vaccine** would have provided protection against most common serogroups of *N. meningitidis* (A, C, W-135, Y) and is strongly recommended for college students living in dormitories due to increased risk of transmission.
*Intravenous vancomycin*
- This is an **acute treatment** for bacterial meningitis, specifically active against *Streptococcus pneumoniae* and some resistant strains.
- It would not have **prevented** the condition; preventative measures are typically vaccines or prophylactic antibiotics.
*Erythromycin therapy*
- Erythromycin is an antibiotic used for various bacterial infections, including atypical pneumonia and some skin infections.
- It is **not the primary prophylactic agent** for meningococcal disease and would not have prevented this specific condition.
*Doxycycline therapy*
- Doxycycline is a broad-spectrum antibiotic used for a range of infections, including tick-borne diseases and certain respiratory infections.
- It is **not indicated for the prevention** of meningococcal meningitis.
*Toxoid vaccine*
- **Toxoid vaccines** protect against diseases caused by bacterial toxins, such as tetanus and diphtheria.
- *Neisseria meningitidis* causes disease primarily through direct invasion and immune response to its capsular polysaccharides, not primarily exotoxins, so a toxoid vaccine would not be effective here.
Travel vaccines for children US Medical PG Question 2: A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines. She does not walk yet but stands in place and can say a few words. The toddler drinks formula and eats a mixture of soft vegetables and pureed meals. She has no current medications. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/50 mm Hg, pulse 130/min, and respiratory rate 28/min. The patient is alert and responsive. The remainder of the exam is unremarkable. Which of the following is most appropriate for this patient at this visit?
- A. Meningococcal vaccine
- B. Gross motor workup and evaluation
- C. Rotavirus vaccine
- D. Referral for speech pathology
- E. MMR vaccine (Correct Answer)
Travel vaccines for children Explanation: ***MMR vaccine***
- The **measles, mumps, and rubella (MMR) vaccine** is recommended for administration at **12-15 months of age**.
- This timing offers protection against these common childhood diseases, which is especially important for children attending **daycare**.
*Meningococcal vaccine*
- The routine **meningococcal vaccine (MenACWY)** is typically recommended for adolescents at **11-12 years of age**, with a booster at 16 years.
- While there are specific circumstances for earlier vaccination (e.g., high-risk conditions), it is **not routine** for a 12-month-old.
*Gross motor workup and evaluation*
- The patient's motor development, standing in place but not yet walking, is **within the normal range** for a 12-month-old.
- A definitive **gross motor workup** would generally be considered if there were more significant delays or regressions.
*Rotavirus vaccine*
- The **rotavirus vaccine** series is typically given at **2, 4, and 6 months of age**, with the final dose administered no later than **8 months of age**.
- A 12-month-old is **outside the recommended age range** for initiating or completing this vaccine series.
*Referral for speech pathology*
- Saying "a few words" at 12 months is **within the normal developmental milestone** for expressive language at this age.
- A referral for **speech pathology** would generally be indicated for more significant language delays.
Travel vaccines for children US Medical PG Question 3: A 2-year-old boy presents for a routine checkup. The patient’s mother says that he has been ‘under the weather’ for the past few days. She did not measure his temperature at home but states that he has felt warm. She denies any episodes of diarrhea or vomiting. No significant past medical history or current medications. The patient attends daycare. He is due for a hepatitis A vaccine. The patient was born at term with no prenatal or perinatal complications. The vital signs include: temperature 37.8°C (100.1°F), blood pressure 112/62 mm Hg, pulse 80/min, respiratory rate 18/min, and oxygen saturation 99% on room air. The patient is alert and responsive. The physical exam is unremarkable. Which of the following is the most appropriate next step in the management of this patient?
- A. Order a complete blood count
- B. Order liver function tests
- C. Strep rapid antigen detection test
- D. Administer the hepatitis A vaccine (Correct Answer)
- E. Delay the hepatitis A immunization until next visit
Travel vaccines for children Explanation: ***Administer the hepatitis A vaccine***
- The patient has a **low-grade fever** (37.8°C), which is generally **not considered a contraindication** for vaccination, especially if the child is otherwise well and active.
- The patient's presentation of being "under the weather" with an unremarkable physical exam and stable vitals suggests a **mild illness**, allowing for routine vaccinations to proceed.
*Order a complete blood count*
- A **CBC is not indicated** at this time, as the patient displays only mild, non-specific symptoms and has a normal physical exam.
- This would be reserved for cases with more concerning signs of infection or systemic illness, such as persistent high fever, lethargy, or specific clinical findings.
*Order liver function tests*
- **Liver function tests are not warranted** as the patient has no symptoms or signs suggestive of liver disease (e.g., jaundice, right upper quadrant pain, dark urine).
- While the patient is due for a hepatitis A vaccine, there is no clinical evidence of active hepatitis or liver dysfunction requiring diagnostic workup.
*Strep rapid antigen detection test*
- The patient has **no symptoms consistent with streptococcal pharyngitis**, such as sore throat, tonsillar exudates, or cervical lymphadenopathy.
- Given the lack of specific symptoms, testing for strep throat would be inappropriate and potentially lead to unnecessary antibiotic use.
*Delay the hepatitis A immunization until next visit*
- Delaying vaccination is only recommended for **moderate to severe acute illnesses** with or without fever, or for certain contraindications.
- A mild illness with low-grade fever, as in this case, is generally **not a reason to postpone** routine immunizations, as per CDC guidelines.
Travel vaccines for children US Medical PG Question 4: A young man about to leave for his freshman year of college visits his physician in order to ensure that his immunizations are up-to-date. Because he is living in a college dormitory, his physician gives him a vaccine that prevents meningococcal disease. What type of vaccine did this patient likely receive?
- A. Live, attenuated
- B. Killed, attenuated
- C. Toxoid
- D. Conjugated polysaccharide (Correct Answer)
- E. Killed, inactivated
Travel vaccines for children Explanation: ***Conjugated polysaccharide***
- The **meningococcal vaccine** commonly administered to college students is a **polysaccharide vaccine** wherein the polysaccharide antigens are conjugated to a protein carrier.
- This **conjugation** improves the immune response by converting a T-independent antigen into a T-dependent one, inducing better memory responses and allowing for vaccination of infants.
*Live, attenuated*
- Live, attenuated vaccines contain a **weakened form of the pathogen** that can replicate but does not cause disease, such as the MMR or varicella vaccine.
- While they elicit strong, long-lasting immunity, the meningococcal vaccine is not typically of this type due to the risk of opportunistic infection, especially in immunocompromised individuals.
*Killed, attenuated*
- This term is a **contradiction**; vaccines are either **killed (inactivated)** or **live (attenuated)**, but not both.
- Attenuation implies weakening, for which the organism would still be alive.
*Toxoid*
- **Toxoid vaccines** are made from inactivated bacterial toxins, used to protect against diseases where the toxin, not the bacterium itself, causes the disease, such as diphtheria and tetanus.
- Meningococcal disease is primarily caused by **direct bacterial invasion and inflammation**, not solely by a toxin.
*Killed, inactivated*
- **Killed, inactivated vaccines** contain whole pathogens that have been killed and cannot replicate, such as the inactivated poliovirus vaccine.
- While there are inactivated meningococcal vaccines, the most common type for broad use, especially in college settings, is the conjugated polysaccharide vaccine, which elicits a stronger and more long-lasting immune response against multiple serotypes compared to plain inactivated whole-cell vaccines.
Travel vaccines for children US Medical PG Question 5: A 1-year-old girl is brought to the physician for a well-child examination. She has no history of serious illness. She receives a vaccine in which a polysaccharide is conjugated to a carrier protein. Which of the following pathogens is the most likely target of this vaccine?
- A. Hepatitis A virus
- B. Varicella zoster virus
- C. Streptococcus pneumoniae (Correct Answer)
- D. Bordetella pertussis
- E. Clostridium tetani
Travel vaccines for children Explanation: ***Streptococcus pneumoniae***
- This pathogen is a common cause of **pneumonia**, **otitis media**, and **meningitis** in young children. The **pneumococcal conjugate vaccine (PCV)** targets *Streptococcus pneumoniae*'s polysaccharide capsule by conjugating it to a carrier protein.
- Conjugating the polysaccharide to a protein carrier allows for a **T-cell-dependent immune response**, which is crucial for eliciting a robust and long-lasting antibody response in infants and young children, whose immune systems are not yet mature enough to respond effectively to unconjugated polysaccharide antigens.
*Hepatitis A virus*
- The vaccine for **Hepatitis A virus** is an **inactivated vaccine** containing whole killed virus particles, not a polysaccharide conjugated to a carrier protein.
- It is typically given to children to prevent **Hepatitis A infection**, which causes liver inflammation.
*Varicella zoster virus*
- The **varicella vaccine** for **Varicella zoster virus** is a **live, attenuated vaccine**, meaning it contains a weakened form of the live virus.
- This vaccine aims to prevent **chickenpox** and is not a polysaccharide-protein conjugate vaccine.
*Bordetella pertussis*
- The vaccine for **Bordetella pertussis** (whooping cough) is part of the **DTaP vaccine** and is an **acellular vaccine**, containing purified components of the bacterium.
- These components are primarily **toxoids** (inactivated toxins) or other bacterial proteins, not polysaccharides.
*Clostridium tetani*
- The vaccine for **Clostridium tetani** is a **toxoid vaccine**, meaning it contains an inactivated form of the **tetanus toxin**.
- This is part of the **DTaP vaccine** and works by stimulating an immune response against the toxin, not bacterial polysaccharides.
Travel vaccines for children US Medical PG Question 6: A 15-month-old girl is brought to her primary care physician for a follow-up visit to receive the 4th dose of her DTaP vaccine. She is up-to-date on her vaccinations. She received her 1st dose of MMR, 1st dose of varicella, 3rd dose of HiB, 4th dose of PCV13, and 3rd dose of polio vaccine 3 months ago. Thirteen days after receiving these vaccinations, the child developed a fever up to 40.5°C (104.9°F) and had one generalized seizure that lasted for 2 minutes. She was taken to the emergency department. The girl was sent home after workup for the seizure was unremarkable and her temperature subsided with acetaminophen therapy. She has not had any other symptoms since then. She has no history of serious illness and takes no medications. Her mother is concerned about receiving further vaccinations because she is afraid of the girl having more seizures. Her vital signs are within normal limits. Examination shows no abnormalities. Which of the following is the most appropriate recommendation at this time?
- A. Administration of the DTaP vaccine as scheduled (Correct Answer)
- B. Administration of the DTaP vaccine with valproic acid
- C. Administration of a reduced-dose DTaP vaccine
- D. Refrain from administration of the DTaP vaccine
- E. Administration of the DTaP vaccine with prophylactic aspirin
Travel vaccines for children Explanation: ***Administration of the DTaP vaccine as scheduled***
- The seizure experienced by the child was a **febrile seizure**, triggered by a fever following vaccination, and not a contraindication to future DTaP doses.
- The timing of the seizure (**13 days post-vaccination**) suggests it was most likely related to the **MMR vaccine**, which commonly causes delayed fever (5-12 days) and febrile seizures, rather than the pertussis component or other vaccines given simultaneously.
- Since the child did **not receive DTaP** at the visit when the febrile seizure occurred, there is no evidence that pertussis-containing vaccines trigger seizures in this patient.
- The **unremarkable workup** and the child's return to normal health indicate the seizure was benign and not indicative of an underlying seizure disorder or severe adverse reaction.
- **Simple febrile seizures are not a contraindication** to DTaP vaccination per CDC/ACIP guidelines.
*Administration of the DTaP vaccine with valproic acid*
- **Valproic acid** is an anti-epileptic drug and is not indicated for the prevention of simple febrile seizures following vaccination.
- Prophylactic use of anti-epileptic drugs for vaccination-related febrile seizures is generally not recommended due to potential side effects and lack of clear benefit.
*Administration of a reduced-dose DTaP vaccine*
- There is **no such thing as a reduced-dose DTaP vaccine** for standard administration in children of this age.
- Reducing the vaccine dose would compromise its efficacy and protective immunity.
*Refrain from administration of the DTaP vaccine*
- **Febrile seizures are not a contraindication** to receiving further DTaP vaccination.
- Withholding the vaccine would leave the child unprotected against **diphtheria, tetanus, and pertussis**, which are serious and potentially life-threatening diseases.
*Administration of the DTaP vaccine with prophylactic aspirin*
- **Aspirin is contraindicated in children** due to the risk of **Reye's syndrome**, especially during viral illnesses or when fever is present.
- It should not be used as a prophylactic measure for vaccination-related fever or seizures.
Travel vaccines for children US Medical PG Question 7: A 19-year-old male arrives to student health for an annual check up. He is up to date on his infant and childhood vaccinations up to age 10. At age 12, he received a single dose of the tetanus, diphtheria, and acellular pertussis vaccine, and a quadrivalent meningococcal conjugate vaccine. A month ago, he received the influenza vaccine. The patient has no significant medical history. He takes over the counter ibuprofen for occasional headaches. He has a father with hypertension and hyperlipidemia, and his brother has asthma. He is sexually active with his current girlfriend. He denies tobacco use, illicit drug use, and recent or future travel. The patient’s temperature is 98°F (36.7°C), blood pressure is 118/78 mmHg, pulse is 70/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. A physical examination is normal. What of the following is the best recommendation for vaccination?
- A. Human papillomavirus vaccine (Correct Answer)
- B. Hepatitis A vaccine
- C. Herpes zoster vaccine
- D. Pneumococcal vaccine
- E. Tetanus and reduced diphtheria toxoid booster
Travel vaccines for children Explanation: ***Human papilloma virus***
- This patient, being 19 years old and **sexually active**, is a prime candidate for the **HPV vaccine** to prevent infections that can lead to various cancers.
- The CDC recommends routine HPV vaccination at age 11-12, but catch-up vaccination is recommended for individuals up to age 26 if not adequately vaccinated previously.
*Hepatitis A vaccine*
- The Hepatitis A vaccine is generally recommended for individuals at **increased risk** of infection, such as travelers to endemic areas, men who have sex with men, or those with chronic liver disease, none of which apply to this patient.
- There is no indication for routine vaccination without specific risk factors in this otherwise healthy young male.
*Herpes zoster vaccine*
- The herpes zoster (shingles) vaccine is recommended for adults **age 50 years and older** to prevent shingles.
- This patient is only 19 years old, making him too young for this vaccine recommendation.
*Pneumococcal vaccine*
- Pneumococcal vaccines (PCV13 and PPSV23) are typically recommended for **young children**, adults **65 years and older**, or individuals with **certain underlying medical conditions** (e.g., chronic heart, lung, or kidney disease, or immunocompromised states).
- This 19-year-old patient has no such risk factors for pneumococcal disease.
*Tetanus and reduced diphtheria toxoid booster*
- The patient received a Tdap vaccine at age 12. A Td booster is recommended **every 10 years** for adults.
- Since it has been only 7 years since his last Tdap vaccine, he is not due for a Td booster at this time.
Travel vaccines for children US Medical PG Question 8: A parent presents to her pediatrician requesting information about immunizations for her newborn. The pediatrician explains about basic principles of immunization, types of vaccines, possible adverse effects, and the immunization schedule. Regarding how immunizations work, the pediatrician explains that there are mainly 2 types of vaccines. The first type of vaccine provides stronger and more lasting immunity as it induces both cellular and humoral immune responses. The second type of vaccine produces mainly a humoral response only, and its overall efficacy is less as compared to the first type. Which of the following vaccines belongs to the first type of vaccine that the pediatrician is talking about?
- A. Hepatitis A vaccine
- B. Polio vaccine (Salk)
- C. Yellow fever vaccine (Correct Answer)
- D. Rabies vaccine
- E. Hepatitis B vaccine
Travel vaccines for children Explanation: ***Yellow fever vaccine***
- The Yellow fever vaccine is a **live-attenuated vaccine**, which mimics natural infection and effectively stimulates both **cellular and humoral immune responses**, leading to strong and long-lasting immunity.
- Live-attenuated vaccines contain a weakened form of the pathogen, allowing for replication within the host and robust immune system activation.
*Hepatitis A vaccine*
- The Hepatitis A vaccine is an **inactivated vaccine**, which primarily induces a **humoral (antibody-mediated) immune response**.
- Inactivated vaccines generally do not stimulate a strong cellular immune response and often require booster doses to maintain protective immunity.
*Polio vaccine (Salk)*
- The Salk polio vaccine is an **inactivated polio vaccine (IPV)**, meaning it contains killed viral particles.
- As an inactivated vaccine, it mainly elicits a **humoral immune response** producing circulating antibodies but less mucosal or cellular immunity.
*Rabies vaccine*
- The Rabies vaccine is an **inactivated vaccine** given after exposure or for pre-exposure prophylaxis.
- It primarily induces a **humoral antibody response** rather than a strong cellular immune response.
*Hepatitis B vaccine*
- The Hepatitis B vaccine is a **recombinant vaccine**, containing only a portion of the viral antigen (HBsAg).
- This type of vaccine primarily stimulates a **humoral immune response** leading to antibody production, which is effective but does not typically induce a strong cellular response like live vaccines.
Travel vaccines for children US Medical PG Question 9: A 34-year-old man comes to the physician for a routine health maintenance examination. He was diagnosed with HIV 8 years ago. He is currently receiving triple antiretroviral therapy. He is sexually active and uses condoms consistently. He is planning a trip to Thailand with his partner to celebrate his 35th birthday in 6 weeks. His last tetanus and diphtheria booster was given 4 years ago. He received three vaccinations against hepatitis B 5 years ago. He had chickenpox as a child. Other immunization records are unknown. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Leukocyte count shows 8,700/mm3, and CD4+ T-lymphocyte count is 480 cells/mm3 (Normal ≥ 500); anti-HBs is 150 mIU/mL. Which of the following recommendations is most appropriate at this time?
- A. Yellow fever vaccine
- B. Hepatitis B vaccine
- C. Tetanus, diphtheria, pertussis vaccine (Tdap)
- D. Measles, mumps, rubella vaccine
- E. No vaccination (Correct Answer)
Travel vaccines for children Explanation: ***Correct: No vaccination***
- Given the patient's current immunization status and clinical scenario, **none of the listed vaccines are indicated at this time**.
- His CD4+ count of 480 cells/mm³ indicates relatively preserved immune function on effective antiretroviral therapy.
- His **anti-HBs level of 150 mIU/mL** demonstrates **adequate hepatitis B immunity** (protective level ≥10 mIU/mL).
- His **tetanus-diphtheria booster was given 4 years ago**, and routine boosters are recommended every **10 years**, so he is not due for another 6 years.
*Incorrect: Yellow fever vaccine*
- **Thailand is not a yellow fever endemic country**, so yellow fever vaccination is **not required or recommended** for travel there.
- Yellow fever vaccine is a **live attenuated vaccine** that can be given to HIV-positive patients with **CD4+ counts ≥200 cells/mm³** when travel to endemic areas (parts of Africa and South America) is necessary.
- Since the patient has a CD4+ count of 480 and Thailand doesn't require this vaccine, this is not applicable.
*Incorrect: Hepatitis B vaccine*
- The patient's **anti-HBs level of 150 mIU/mL** indicates **adequate protective immunity** against hepatitis B.
- A level ≥10 mIU/mL is considered protective, so **no booster is needed**.
*Incorrect: Tetanus, diphtheria, pertussis vaccine (Tdap)*
- **Tetanus-diphtheria boosters are recommended every 10 years**.
- The patient received his last booster **4 years ago**, so he is **not due** for another booster at this time.
- There is no specific indication for **pertussis vaccination** (e.g., pregnancy, close contact with infants).
*Incorrect: Measles, mumps, rubella vaccine*
- **MMR is a live attenuated vaccine** that is **contraindicated** in HIV-positive individuals with **CD4+ counts <200 cells/mm³**.
- While this patient's CD4+ count is 480, MMR should only be given to HIV patients if they lack immunity and have CD4 ≥200.
- There is **no documented need** for MMR based on the clinical scenario provided, and his immunity status to these infections is unknown.
- Without evidence of susceptibility or specific exposure risk, vaccination is not indicated.
Travel vaccines for children US Medical PG Question 10: A 12-month-old boy presents for a routine checkup. The patient immigrated from the Philippines with his parents a few months ago. No prior immunization records are available. The patient’s mother claims that he had a series of shots at 6 months of age which gave him a severe allergic reaction with swelling of the tongue and the face. She also remembers that he had the same reaction when she introduced solid foods to his diet, including carrots, eggs, and bananas. Which of the following vaccinations are not recommended for this patient?
- A. Measles, mumps, and rubella (MMR) vaccine
- B. Hepatitis B vaccine
- C. Varicella vaccine
- D. Intranasal influenza vaccine
- E. Intramuscular influenza vaccine (Correct Answer)
Travel vaccines for children Explanation: ***Important Note on Current Guidelines***
Based on **current CDC/ACIP guidelines (2023-2024)**, egg allergy alone is **no longer a contraindication** to influenza vaccines. However, this question tests knowledge of vaccine safety in the context of **severe anaphylaxis to a prior vaccination**.
***Intramuscular influenza vaccine***
- **Historically**, this was considered the most concerning option for patients with severe egg allergy, as many influenza vaccines were produced using egg-based culture methods
- **Current practice**: Per CDC guidelines, persons with egg allergy of any severity can receive any age-appropriate influenza vaccine, as egg protein content is minimal or absent in modern formulations
- However, if this patient had a **documented anaphylactic reaction to the influenza vaccine itself** (not just eggs), then it would be contraindicated
- Given the timing (6 months) and symptoms described, this represents the **historically correct answer**, though modern practice has evolved
*Measles, mumps, and rubella (MMR) vaccine*
- MMR vaccine is grown in **chick embryo fibroblast cells**, NOT in eggs, and contains **no egg protein**
- **Safe for patients with egg allergy** - no contraindication based on egg allergy
- Should be administered on schedule for catch-up immunization
*Hepatitis B vaccine*
- Produced using **recombinant DNA technology in yeast cells**
- Contains **no egg protein** and no animal-derived proteins
- **No contraindication** for this patient - safe to administer
*Varicella vaccine*
- Grown in **human diploid cell cultures**, NOT in eggs
- Contains **no egg protein**
- **Safe for patients with egg allergy** - no contraindication
- Should be administered as part of catch-up immunization
*Intranasal influenza vaccine (LAIV)*
- Like the intramuscular formulation, **current guidelines allow administration** to patients with egg allergy of any severity
- Contains similar or less egg protein than inactivated vaccines in modern formulations
- **Not contraindicated** based solely on egg allergy per current CDC guidelines
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