Immunizations

Chapter 100 Immunizations

Clinical Case Problem 1: A 4-Month-Old Infant Who Missed His Shots Because of a Cold at 2 Months of Age

A 4-month-old infant is brought to your office by his mother to see you for the first time. The infant and his mother recently moved to the area. The mother states that when he came for a 2-month examination, the nurse practitioner said the child had a “cold” and could not receive his immunizations. His mother is concerned because he has gotten only his first hepatitis B immunization in the hospital. He is bottle-fed and stays with a relative while the mother works. The infant has had upper respiratory symptoms for the past week; but according to the mother, he is happy, interactive, afebrile, and feeding well. On physical examination, the child is appropriate weight and length for age, smiles, and interacts, and the rest of the examination is completely normal with the exception of minimal clear nasal discharge.

Select the best answer to the following questions

1. Which immunizations should be given to this child now, according to the Advisory Committee on Immunization Practices (ACIP) recommendations?

a. hepatitis B, diphtheria–tetanus–acellular pertussis (DTaP), pneumococcal conjugate vaccine (PCV), inactivated poliomyelitis vaccine (IPV), Haemophilus influenzae type b (Hib)

b. hepatitis B, DTaP, PCV, IPV, Hib, rotavirus

c. DTaP, PCV, IPV, Hib

d. hepatitis B, pneumococcal polysaccharide vaccine (PPV), IPV, Hib

e. hepatitis B, DTaP, PPV, IPV, Hib, rotavirus

2. When do you ask the mother to return to give the child “catch-up” immunizations?

a. 2 weeks and give DTaP, PCV, IPV, Hib, rotavirus

b. 4 weeks and give DTaP, PCV, IPV, Hib

c. 4 weeks and give hepatitis B, DTaP, PCV, IPV, Hib

d. just have the mother return at 6 months to get the routine vaccinations—no further catch-up is required

e. all of the above are acceptable

3. Which of the following statements regarding future immunizations for the child is true?

a. be careful never to give an immunization with a low-grade fever because the child could react

b. he should be given his measles-mumps-rubella (MMR) vaccine at 9 months to make sure he does not miss it

c. reimmunize him according to the catch-up schedule and reassure the mother that a mild upper respiratory infection is no contraindication to immunization

d. because he is late getting his first immunization, he is more likely to have a severe reaction

e. never give an immunization if a child has an upper respiratory infection because fever could be misinterpreted as worsening illness

4. Which of the following statements regarding vaccination against poliomyelitis is true?

a. oral polio vaccine (OPV) is a live, attenuated, trivalent vaccine known as the Salk vaccine

b. OPV and IPV are both available for immunizations, depending on the parent’s preference

c. IPV is an inactivated (killed), trivalent vaccine known as Sabin vaccine

d. the most recent recommendation calls for an all-IPV dosing regimen

e. OPV and IPV are both associated with a small risk of vaccine-associated paralytic poliomyelitis (VAPP)

5. Which of the following statements is true regarding hepatitis B vaccine in children?

a. an extra dose should never be given

b. it is recommended as a routine immunization, and the first dose should not be given before the age of 2 months

c. it is recommended as a routine immunization, and the first dose should be given at 6 months

d. it is recommended as a routine immunization, and the first dose should be given before discharge from the hospital after birth

e. the third dose may be given within 4 weeks of the second dose, but no sooner

6. Which of the following statements is true regarding the rotavirus vaccine?

a. the first dose may be given between 8 and 32 weeks

b. the first dose must be given between 6 and 12 weeks and is routinely given at the 2-month visit

c. the third dose should be given between 12 and 15 months

d. it is an injectable vaccine, available in a combination vaccine

e. because breast-fed babies never get rotavirus, it should not be given to them

7. Which of the following is a contraindication to immunization?

b. recent exposure to an infectious disease

c. current antimicrobial therapy

d. moderate or severe illness with or without a fever

e. history of penicillin or other allergies

8. Which of the following statements regarding immunization against H. influenzae (the Hib vaccine) is (are) true?

a. the vaccine prevents meningitis as well as some other conditions caused by H. influenzae

b. the first dose of Hib vaccine should be given at the age of 2 months

c. if a child presents late for immunizations, the full series of the vaccine may not be required

d. the Hib vaccine has not decreased the incidence of otitis media in infants and children

e. all of the above

9. Which of the following vaccines is (are) recommended for first administration at 12 to 15 months of age?

b. varicella and MMR

e. varicella, MMR, and hepatitis A

10. By the time a child reaches 7 years of age, how many doses of DTaP should have been administered?

e. none of the above

11. Which of the following statements about tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) is false?

a. Tdap is routinely given at 11 to 12 years, followed by Td every 10 years

b. Tdap is relatively contraindicated during the first trimester of pregnancy and preferentially should be given before conception

c. Tdap is given to adolescents in place of one Td booster at the age of 11 to 18 years and may be given to adults up to the age of 65 years, particularly to those who have contact with infants younger than 12 months

d. Tdap may replace Td for all boosters to decrease pertussis risk in the population and should be given every 10 years

e. Tdap provides a way to decrease the resurgence of pertussis in the adult population

12. Which of the following vaccines is not recommended for a well-child visit at the age of 11 to 13 years in a girl who is up to date on her vaccines?

b. meningococcal

d. human papillomavirus (HPV)

e. influenza (in season)

13. Which of the following is false regarding the varicella vaccine?

a. it should not be given before 12 months of age

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Tags: Swansons Family Medicine Review

Oct 1, 2016 | Posted by admin in GENERAL SURGERY | Comments Off

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