Adult immunization recommendations — MCQs

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 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?

A 7-year-old African-American boy presents to his physician with fatigue, bone and abdominal pain, and mild jaundice. The pain is dull and remitting, and the patient complains it sometimes migrates from one extremity to another. His mother reports that his jaundice and pain have occurred periodically for the past 5 years. At the time of presentation, his vital signs are as follows: the blood pressure is 80/50 mm Hg, the heart rate is 87/min, the respiratory rate is 17/min, and the temperature is 36.5°C (97.7°F). On physical examination, the patient appears to be pale with mildly icteric sclera and mucous membranes. On auscultation, there is a soft systolic ejection murmur, and palpation reveals hepatosplenomegaly. His musculoskeletal examination shows no abnormalities. Laboratory investigations show the following results: Complete blood count Erythrocytes 3.7 x 106/mm3 Hgb 11 g/dL Total leukocyte count Neutrophils Lymphocytes Eosinophils Monocytes Basophils 7,300/mm3 51% 40% 2% 7% 0 Platelet count 151,000/mm3 Chemistry Total bilirubin 3.1 mg/dL (53 µmol/L) Direct bilirubin 0.5 mg/dL (8.55 µmol/L) A peripheral blood smear shows numerous sickle-shaped red blood cells. Among other questions, the patient’s mother asks you how his condition would influence his vaccination schedule. Which of the following statements is true regarding vaccination in this patient?

A 29-year-old man presents to the primary care clinic in June for post-discharge follow-up. The patient was recently admitted to the hospital after a motor vehicle collision. At that time he arrived at the emergency department unconscious, hypotensive, and tachycardic. Abdominal CT revealed a hemoperitoneum due to a large splenic laceration; he was taken to the operating room for emergency splenectomy. Since that time he has recovered well without complications. Prior to the accident, he was up-to-date on all of his vaccinations. Which of the following vaccinations should be administered at this time?

A 27-year-old G0P0 female presents to her OB/GYN for a preconception visit to seek advice before becoming pregnant. A detailed history reveals no prior medical or surgical history, and she appears to be in good health currently. Her vaccination history is up-to-date. She denies tobacco or recreational drug use and admits to drinking 2 glasses of wine per week. She states that she is looking to start trying to become pregnant within the next month, hopefully by the end of January. Which of the following is NOT recommended as a next step for this patient's preconception care?

A 27-year-old man presents to the family medicine clinic for a routine check-up. The patient recently accepted a new job at a childcare center and the employer is requesting his vaccination history. After checking the records from the patient’s childhood, the physician realizes that the patient never had the varicella vaccine. The patient is unsure if he had chickenpox as a child, and there is no record of him having had the disease in the medical record. There is no significant medical history, and the patient takes no current medications. The patient’s heart rate is 82/min, respiratory rate is 14/min, temperature is 37.5°C (99.5°F), and blood pressure is 120/72 mm Hg. The patient appears alert and oriented. Auscultation of the heart reveals no murmurs, rubs, or gallops. The lungs are clear to auscultation bilaterally. With regard to the varicella vaccine, which of the following is recommended for the patient at this time?

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 1-year-old immigrant girl has not received any recommended vaccines since birth. She attends daycare and remains healthy despite her daily association with several other children for the past 3 months at a home day-care facility. Which of the following phenomena explains why she has not contracted any vaccine-preventable diseases such as measles, diphtheria, or pertussis?

A 45-year-old man with a history of poorly controlled human immunodeficiency virus (HIV) infection presents to the emergency room complaining of clumsiness and weakness. He reports a 3-month history of worsening balance, asymmetric muscle weakness, and speech difficulties. He recently returned from a trip to Guatemala to visit his family. He has been poorly compliant with his anti-retroviral therapy and his most recent CD4 count was 195. His history is also notable for rheumatoid arthritis and hepatitis C. His temperature is 99°F (37.2°C), blood pressure is 140/90 mmHg, pulse is 95/min, and respirations are 18/min. On exam, he has 4/5 strength in his right upper extremity, 5/5 strength in his left upper extremity, 5/5 strength in his right lower extremity, and 3/5 strength in his left lower extremity. His speech is disjointed with intermittent long pauses between words. Vision is 20/100 in the left eye and 20/40 in his right eye; previously, his eyesight was 20/30 bilaterally. This patient most likely has a condition caused by which of the following types of pathogens?

A 48-year-old man with HIV comes to the physician because of skin lesions over his face and neck for 2 weeks. They are not itchy or painful. He does not have fever or a sore throat. He was treated for candidal esophagitis 3 months ago. He is sexually active with his wife, who knows of his condition, and uses condoms consistently. He is currently receiving triple antiretroviral therapy with lamivudine, abacavir, and efavirenz. He is 175 cm (5 ft 9 in) tall and weighs 58 kg (128 lb); BMI is 18.8 kg/m2. Examination shows multiple skin colored papules over his face and neck with a dimpled center. Cervical lymphadenopathy is present. The remainder of the examination is unremarkable. His hemoglobin concentration is 12.1 g/dL, leukocyte count is 4,900/mm3, and platelet count is 143,000/mm3; serum studies and urinalysis show no abnormalities. CD4+ T-lymphocyte count is 312/mm3 (normal ≥ 500). Which of the following is the most likely cause of this patient's findings?