A 23-year-old woman presents to her physician requesting the chickenpox vaccine. She is also complaining of nausea, malaise, and moderate weight gain. She developed these symptoms gradually over the past 2 weeks. She reports no respiratory or cardiovascular disorders. Her last menstruation was about 6 weeks ago. She has one sexual partner and uses a natural planning method for contraception. Her vital signs include: blood pressure 110/70 mm Hg, heart rate 92/min, respiratory rate 14/min, and temperature 37.2℃ (99℉). The physical examination shows non-painful breast engorgement and nipple hyperpigmentation. There is no neck enlargement and no palpable nodules in the thyroid gland. The urine beta-hCG is positive. What is the proper recommendation regarding chickenpox vaccination in this patient?
AConfirm pregnancy with serum beta-hCG and if positive delay administration of the vaccine until the third trimester.
BPerform varicella viral load and schedule the vaccine based on these results.
CConfirm pregnancy with serum beta-hCG and if positive, postpone administration of the vaccine until after completion of the pregnancy.
DSchedule the vaccination.
EConfirm pregnancy with serum beta-hCG and if positive, schedule the patient for pregnancy termination.
A 28-year-old woman presents to her physician for follow-up. She was found to be HIV-positive 9 months ago. Currently she is on ART with lamivudine, tenofovir, and efavirenz. She has no complaints and only reports a history of mild respiratory infection since the last follow-up. She is also allergic to egg whites. Her vital signs are as follows: the blood pressure is 120/75 mm Hg, the heart rate is 73/min, the respiratory rate is 13/min, and the temperature is 36.7°C (98.0°F). She weighs 68 kg (150 lb), and there is no change in her weight since the last visit. On physical examination, she appears to be pale, her lymph nodes are not enlarged, her heart sounds are normal, and her lungs are clear to auscultation. Her total blood count shows the following findings: Erythrocytes 3.2 x 106/mm3 Hematocrit 36% Hgb 10 g/dL Total leukocyte count 3,900/mm3 Neutrophils 66% Lymphocytes 24% Eosinophils 3% Basophils 1% Monocytes 7% Platelet count 280,000/mm3 Her CD4+ cell count is 430 cells/µL. The patient tells you she would like to get an influenza vaccination as flu season is coming. Which of the following statements is true regarding influenza vaccination in this patient?
AAs long as the patient is anemic, she should not be vaccinated.
BInfluenza vaccination is contraindicated in HIV-positive patients because of the serious complications they can cause in immunocompromised people.
CInactivated or recombinant influenza vaccines fail to induce a sufficient immune response in patients with CD4+ cell counts under 500 cells/µL.
DNasal-spray influenza vaccine is the best option for vaccination in this patient.
EThe patient can receive approved recombinant or inactivated influenza vaccines, with egg-free formulations preferred due to her egg allergy.
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?
AMeasles, mumps, and rubella (MMR)
BVaricella vaccine
CHerpes zoster vaccine
DLive attenuated influenza vaccine
ETetanus, diphtheria, and acellular pertussis (Tdap)
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