Vaccine storage and handling US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Vaccine storage and handling. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Vaccine storage and handling US Medical PG Question 1: A 29-year-old man comes to the physician for a routine health maintenance examination. He feels well. He works as a nurse at a local hospital in the city. Three days ago, he had a needlestick injury from a patient whose serology is positive for hepatitis B. He completed the 3-dose regimen of the hepatitis B vaccine 2 years ago. His other immunizations are up-to-date. He appears healthy. Physical examination shows no abnormalities. He is concerned about his risk of being infected with hepatitis B following his needlestick injury. Serum studies show negative results for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis C antibody. Which of the following is the most appropriate next step in management?
- A. Revaccinate with 3-dose regimen of hepatitis B vaccine
- B. Revaccinate with two doses of hepatitis B vaccine
- C. Administer hepatitis B immunoglobulin
- D. Administer hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine (Correct Answer)
- E. Administer hepatitis B immunoglobulin and single dose hepatitis B vaccine
Vaccine storage and handling Explanation: ***Administer hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine***
- This patient had prior vaccination but current serology shows **negative HBsAb**, indicating **non-response** to the vaccine (failure to develop protective antibodies).
- Given exposure to a hepatitis B positive patient, immediate post-exposure prophylaxis with **HBIG** is crucial for passive immunity and immediate protection.
- A **complete 3-dose revaccination series** should be initiated simultaneously, as per **CDC/ACIP guidelines** for vaccine non-responders with occupational exposure [1].
- This provides both immediate passive protection (HBIG) and attempts to establish active immunity through revaccination [1].
*Revaccinate with 3-dose regimen of hepatitis B vaccine*
- While revaccination is necessary due to the non-response, starting a 3-dose regimen alone without **HBIG** would leave the patient vulnerable during the initial period before vaccine response develops.
- After high-risk exposure in a non-responder, both passive (HBIG) and active (vaccine) immunity are required.
*Revaccinate with two doses of hepatitis B vaccine*
- A 2-dose regimen is insufficient; the standard revaccination schedule for non-responders is **3 doses** at 0, 1, and 6 months [1].
- Additionally, this option lacks **HBIG** for immediate protection after the high-risk exposure.
*Administer hepatitis B immunoglobulin*
- **HBIG** alone provides immediate passive immunity, which is crucial given the recent exposure and the patient's non-immune status.
- However, offering only HBIG without initiating active immunization (vaccine series) would leave the patient unprotected once the passive immunity wanes (approximately 3-6 months).
- This approach fails to address the need for long-term protection through revaccination.
*Administer hepatitis B immunoglobulin and single dose hepatitis B vaccine*
- While HBIG is appropriate for immediate protection, giving only a **single dose** of vaccine is inadequate.
- Standard post-exposure management for vaccine non-responders requires initiating a **complete 3-dose revaccination series**, not just one dose [1].
- A single dose would not provide adequate long-term protection for this non-responder.
Vaccine storage and handling US Medical PG Question 2: A scientist in Chicago is studying a new blood test to detect Ab to EBV with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years of work, she believes that she has actually managed to reach a sensitivity and specificity much greater than what she had originally hoped for. She travels to China to begin testing her newest blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with EBV. The scientist tests these 1,200 patients' blood and finds that only 120 of them tested negative with her new exam. Of the patients who are known to be EBV-free, only 20 of them tested positive. Given these results, which of the following correlates with the exam's specificity?
- A. 82%
- B. 90%
- C. 84%
- D. 86%
- E. 98% (Correct Answer)
Vaccine storage and handling Explanation: ***98%***
- **Specificity** measures the proportion of **true negatives** among all actual negatives.
- In this case, 800 patients are known to be EBV-free (actual negatives), and 20 of them tested positive (false positives). This means 800 - 20 = 780 tested negative (true negatives). Specificity = (780 / 800) * 100% = **98%**.
*82%*
- This value represents the *original sensitivity* before the scientist’s new attempts to improve the test.
- It does not reflect the *newly calculated specificity* based on the provided data.
*90%*
- This value represents the *newly calculated sensitivity* of the test, not the specificity.
- Out of 1200 EBV-infected patients, 120 tested negative (false negatives), meaning 1080 tested positive (true positives). Sensitivity = (1080 / 1200) * 100% = 90%.
*84%*
- This percentage is not directly derived from the information given for either sensitivity or specificity after the new test results.
- It does not correspond to any of the calculated values for the new test's performance.
*86%*
- This percentage is not directly derived from the information given for either sensitivity or specificity after the new test results.
- It does not correspond to any of the calculated values for the new test's performance.
Vaccine storage and handling US Medical PG Question 3: 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)
Vaccine storage and handling 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.
Vaccine storage and handling US Medical PG Question 4: 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
Vaccine storage and handling 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.
Vaccine storage and handling US Medical PG Question 5: The occupational health department at a hospital implements new safety precautions to prevent laboratory-acquired infections. One of the new precautions includes disinfecting the microbiology laboratory benches with 70% ethanol before and after use. This measure is most likely to be effective in preventing the transmission of which of the following viruses?
- A. Hepatitis A virus
- B. Herpes simplex virus (Correct Answer)
- C. Poliovirus
- D. Parvovirus
- E. Polyomavirus
Vaccine storage and handling Explanation: ***Herpes simplex virus***
- Herpes simplex virus is an **enveloped virus**, meaning it has a lipid outer layer that is easily disrupted by disinfectants like **70% ethanol**.
- The disruption of its envelope renders the virus inactive and unable to infect host cells, making this a highly effective prevention strategy.
*Hepatitis A virus*
- Hepatitis A virus is a **non-enveloped virus**, making it relatively **resistant to many common disinfectants**, including alcohol-based ones.
- Its robust protein capsid protects its genetic material, requiring stronger disinfection methods than 70% ethanol for inactivation.
*Poliovirus*
- Poliovirus is another **non-enveloped virus** that exhibits significant **resistance to alcohol-based disinfectants** due to its stable protein capsid.
- Effective inactivation typically requires disinfectants with greater germicidal activity, such as chlorine-based solutions.
*Parvovirus*
- Parvovirus is one of the **most resistant non-enveloped viruses** to disinfection, including inactivation by 70% ethanol.
- Its small size and extremely stable capsid make it challenging to eliminate from surfaces, often necessitating harsh chemical treatments.
*Polyomavirus*
- Polyomaviruses are **non-enveloped DNA viruses** that are generally more **resistant to alcohol-based disinfectants** than enveloped viruses.
- Their lack of a lipid envelope provides protection against agents like ethanol that target lipid bilayers.
Vaccine storage and handling US Medical PG Question 6: 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
Vaccine storage and handling 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.
Vaccine storage and handling US Medical PG Question 7: A 35-year-old man is brought to the emergency department by his wife because of a 1-week history of progressive confusion, myalgia, and nausea. His wife says that he first reported headaches and fatigue 10 days ago, and since then “he has not been himself”. He has refused to drink any liquids for the last day. Two months ago, he helped his neighbor remove a raccoon's den from her backyard. He appears agitated. His temperature is 100.8°F (38.2°C). Examination shows excessive drooling. Muscle tone and deep tendon reflexes are increased bilaterally. Administration of which of the following is most likely to have prevented this patient's condition?
- A. Inosine monophosphate dehydrogenase inhibitor
- B. RNA-dependent DNA polymerase inhibitor
- C. Live attenuated vaccine
- D. Chemically-inactivated virus (Correct Answer)
- E. Immunoglobulin against a bacterial protein
Vaccine storage and handling Explanation: ***Chemically-inactivated virus***
- This patient presents with symptoms highly suggestive of **rabies**, including progressive confusion, myalgias, agitation, excessive drooling, and increased muscle tone, following exposure to a raccoon.
- The rabies vaccine is a **chemically-inactivated virus** type that induces active immunity, and post-exposure prophylaxis with this vaccine (along with rabies immunoglobulin) would have prevented the disease.
*Inosine monophosphate dehydrogenase inhibitor*
- **Inosine monophosphate dehydrogenase inhibitors** (e.g., mycophenolate mofetil) are immunosuppressants used to prevent organ transplant rejection or treat autoimmune diseases.
- They do not have a role in preventing or treating viral infections like rabies.
*RNA-dependent DNA polymerase inhibitor*
- **RNA-dependent DNA polymerase inhibitors** (e.g., reverse transcriptase inhibitors) are mainly used in the treatment of **HIV infection**, a retrovirus that uses reverse transcriptase.
- Rabies virus is an RNA virus (rhabdovirus), but it does not use reverse transcriptase, and these inhibitors are not effective against it.
*Live attenuated vaccine*
- While many effective viral vaccines are **live attenuated** (e.g., MMR, varicella), the rabies vaccine used for post-exposure prophylaxis and prevention is not live attenuated, due to safety concerns.
- A live attenuated vaccine, if available and safe, would induce a strong immune response, but it is not the type of vaccine used for rabies in humans.
*Immunoglobulin against a bacterial protein*
- This describes antitoxins or immunoglobulins used against **bacterial infections** or their toxins (e.g., tetanus antitoxin).
- Rabies is a viral infection, and while passive immunization with **rabies immunoglobulin** is part of post-exposure prophylaxis, it is specific to the rabies virus and not a bacterial protein.
Vaccine storage and handling US Medical PG Question 8: A 28-year-old woman comes to the emergency department for a 1-week history of jaundice and nausea. She recalls eating some seafood last weekend at a cookout. She lives at home with her 2-year-old son who attends a daycare center. The child's immunizations are up-to-date, and his last hepatitis A vaccine was administered 6 weeks ago. The woman's temperature is 37.5°C (99.5°F), pulse is 82/min, and blood pressure is 134/84 mm Hg. Examination shows scleral icterus. The liver is palpated 2-cm below the right costal margin and is tender. Her serum studies show:
Total bilirubin 3.4 mg/dL
Alkaline phosphatase 89 U/L
AST 185 U/L
ALT 723 U/L
Hepatitis A IgM antibody positive
Hepatitis B surface antibody positive
Hepatitis B surface antigen negative
Hepatitis B core IgM antibody negative
Hepatitis C antibody negative
Which of the following health maintenance recommendations is most appropriate for the child at this time?
- A. Isolate the child
- B. Administer hepatitis B immunoglobulin and hepatitis B vaccine
- C. No additional steps are needed (Correct Answer)
- D. Administer hepatitis B immunoglobulin only
- E. Administer hepatitis A vaccine and hepatitis A immunoglobulin
Vaccine storage and handling Explanation: ***No additional steps are needed***
- The child received his **last hepatitis A vaccine 6 weeks ago**, which provides adequate protection against hepatitis A infection.
- According to **CDC/ACIP guidelines**, children who have received **at least one dose** of hepatitis A vaccine do **not require post-exposure prophylaxis** (neither additional vaccine nor immunoglobulin) after exposure to hepatitis A.
- One dose of hepatitis A vaccine provides protection within **2-4 weeks**, and since 6 weeks have elapsed, the child is already immune.
- The child's **immunizations are up-to-date**, confirming he is on the appropriate hepatitis A vaccination schedule (2-dose series).
*Administer hepatitis A vaccine and hepatitis A immunoglobulin*
- This would be appropriate for **previously unvaccinated** individuals exposed to hepatitis A, immunocompromised patients, or infants under 12 months.
- However, this child has **already been vaccinated** 6 weeks ago and therefore has adequate protection.
- Administering both vaccine and immunoglobulin is **unnecessary** and not indicated per current guidelines when prior vaccination has occurred.
*Isolate the child*
- Isolation is not the primary recommendation for hepatitis A post-exposure management in household contacts.
- The focus should be on **prevention through immunization**, but this child is already protected by prior vaccination.
- Standard hygiene measures (handwashing) are recommended but formal isolation is not necessary.
*Administer hepatitis B immunoglobulin and hepatitis B vaccine*
- The mother's serology shows **HBsAg negative** and **HBsAb positive**, indicating she is **immune to hepatitis B** (likely from prior vaccination) and not currently infected.
- There is **no risk of hepatitis B transmission** from the mother to the child.
- This intervention addresses the wrong infection entirely.
*Administer hepatitis B immunoglobulin only*
- This is inappropriate because the mother does **not have active hepatitis B infection** (HBsAg negative).
- This option does not address the **hepatitis A exposure**, which is the relevant concern in this scenario.
- Hepatitis B immunoglobulin is indicated only for exposure to hepatitis B, not hepatitis A.
Vaccine storage and handling US Medical PG Question 9: An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on inspection, suggesting diphtheria. What is the appropriate prophylaxis for a 2 -year-old contact who has completed their vaccination?
- A. No prophylaxis needed
- B. Toxoid
- C. Immunoglobulins
- D. Penicillin (Correct Answer)
- E. Erythromycin
Vaccine storage and handling Explanation: ***Penicillin***
- For a **fully vaccinated contact** of a diphtheria case, **antibiotic prophylaxis** (e.g., penicillin or erythromycin) is recommended to prevent carriage and transmission of *Corynebacterium diphtheriae*.
- This approach aims to eradicate the organism from the respiratory tract, even if the contact is otherwise protected from the disease itself.
- **Penicillin** is a commonly used first-line agent for this purpose.
*Erythromycin*
- **Erythromycin** is also an acceptable antibiotic for diphtheria prophylaxis and is particularly useful in penicillin-allergic patients.
- Both penicillin and erythromycin are effective for preventing carriage; the choice between them may depend on local guidelines, patient allergies, and availability.
- In this context, either would be clinically appropriate, but penicillin is often listed as the primary option in standard guidelines.
*No prophylaxis needed*
- This is incorrect because even vaccinated individuals can become **asymptomatic carriers** of *C. diphtheriae* and transmit the infection to unimmunized or under-immunized contacts.
- Prophylaxis is crucial for **breaking the chain of transmission** in a household or close contact setting.
*Toxoid*
- **Diphtheria toxoid** is the active component of the diphtheria vaccine, which stimulates the immune system to produce antibodies against diphtheria toxin, preventing the disease.
- While important for ongoing immunity, administering the toxoid as an immediate prophylaxis for a fully vaccinated contact is not the primary intervention for preventing carriage; **antibiotics are used for this purpose**.
*Immunoglobulins*
- **Diphtheria antitoxin** (DAT), which contains immunoglobulins, is used for the **treatment of active diphtheria disease** by neutralizing the circulating toxin.
- It is not indicated for prophylaxis in vaccinated contacts, as their immune system is already primed to handle potential exposure to the toxin, and the goal of prophylaxis here is to prevent colonization rather than toxin effects.
Vaccine storage and handling US Medical PG Question 10: Which vaccine is contraindicated in a 3-monthold infant with recurrent respiratory illness?
- A. DT (Diphtheria and Tetanus)
- B. Measles vaccine
- C. DPT (Diphtheria, Pertussis, Tetanus) (Correct Answer)
- D. Inactivated polio vaccine (IPV)
- E. Hepatitis B vaccine
Vaccine storage and handling Explanation: ***DPT (Diphtheria, Pertussis, Tetanus)***
- While DPT is routinely given in infancy, the **pertussis component** (particularly the whole-cell vaccine formulation) can exacerbate existing **respiratory conditions** or be problematic in infants with a history of **unstable neurological disorders**.
- Recurrent respiratory illness in a 3-month-old may indicate underlying pulmonary compromise, for which the pertussis component's side effects (e.g., fever, fussiness) could be poorly tolerated or confound diagnosis.
*Measles vaccine*
- The measles vaccine (MMR) is typically administered at **12-15 months of age**, not at 3 months.
- Measles vaccine is a **live attenuated vaccine**, but its contraindications are primarily related to severe immunosuppression or recent immunoglobulin receipt, not recurrent respiratory illness in this age group.
*DT (Diphtheria and Tetanus)*
- The DT vaccine (without the pertussis component) is generally considered **safe** for infants and often used if the pertussis component is *contraindicated*.
- This option does not address the specific concern regarding the pertussis component in the context of recurrent respiratory illness.
*Inactivated polio vaccine (IPV)*
- IPV is an **inactivated vaccine**, meaning it contains killed virus, and thus carries a very low risk of vaccine-related adverse events.
- Recurrent respiratory illness is **not a contraindication** for IPV, which is part of routine infant immunization schedules.
*Hepatitis B vaccine*
- Hepatitis B vaccine is an **inactivated vaccine** routinely given at birth and as part of the infant immunization schedule.
- Recurrent respiratory illness is **not a contraindication** for Hepatitis B vaccine, which is safe and well-tolerated in infants.
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