Post5 Vacc/Coag

Which of the following is an example of active immunization?
A. An elderly patient receives an influenza vaccination every year which causes the person
to produce antibodies against influenza virus.
B. An infant receives respiratory syncytial virus intravenous immuneglobulin (RespiGam) every month during winter and spring.
C. An unborn baby receives antibodies from the mom across the placenta.
D. A person receives rabies immune globulin after being bitten by an infected animal.

A 56 yo female (whose last pertussis vaccination was as a child), has a 3 yo child with whooping cough. She asks about spread of infection to herself and her 4 yo son who has received the following vaccinations: 1 MMR, 4 Hib, 3 hepB, 3 IPV and 4 DTaP. You should respond:
1. You and your 4 yo should be protected, but do wash your hands well after caring for your younger child.
2. You should be ok, but your 4 yo should receive pneumococcal conjugated vaccine.
3. Your son should be ok, you need booster if your DtaP is over 10 years.
4. You and your son should both get boosters.

A healthy 47 year old who lives with his healthy wife and works in a library, should receive which vaccination?
A. zoster if antibody titer to chickenpox is low
B. TdaP if not received within the last 10 years
C. influenza if not received within the within the last 10 years
D. pneumococcal pneumonia if not received within the last 5 years

One of your friends tells you that giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system. Your response to this friend should be:
A. You are correct, but only for infants. Very young children (<1 year) cannot make antibodies against more than one antigen at a time.
B. You are correct, but only for older children. Children 6-12 years of age understand the concept of getting a shot to prevent an infection. Psychologically, they do better with one shot for one disease for one visit.
C. You are correct but only for adolescents. It is not until puberty that vaccine boosters work better when separated from other vaccines by at least one month..
D. There have been many studies showing vaccine efficacy when given in combination. Parents save time and money with fewer office visits, which might improve compliance. Kids prefer fewer trips to the clinic and fewer shots too.

Your 65 year old patient has chronic atrial fibrillation of the heart and is at risk for throwing a blood clot to the brain. What drug would be the best choice to prevent blood clot development in this patient?
A. Tissue Plasminogen Activator (TPA)
B. Coumadin (WARFARIN)
C. Heparin
D. Atorvastatin (LIPITOR)

A 60 year old male has risk factors for a myocardial infarction (heart attack) because he smokes, has high blood pressure and has several family members who had heart attacks. What drug should be given to prevent a heart attack?
A. Tissue Plasminogen Activator (TPA)     
B. Coumadin (WARFARIN)     
C. Heparin     
D. Aspirin      

One day after knee surgery, a patient is started on both heparin and coumadin. The rationale for doing this is:
A. Heparin works right away and provides anticoagulation until the coumadin starts working a few days later.
B. Coumadin works right away and provides anticoagulation until the heparin starts working a few days later.
C. Coumadin will reduce the risk of bleeding from the heparin.
D. Heparin will reduce the risk of bleeding from the coumadin.

A patient taking clopidogrel (Plavix) should have which lab test done to monitor for adverse effects?
A. aPTT
B. Hematocrit
C. INR
D. Platelet

Your 80 year old patient tells you he takes the herb ginko and vitamin E to "improve his aging memory". You are alert to the potential for drug interaction with which of his other medications?
A. digoxin
B. furosemide (LASIX)
C. potassium
D. warfarin (COUMADIN)

Common side effects from vaccines include
A. slight fever and pain at the injection site.
B. seizures.
C. generalized pain.
D. vomiting.

A healthy, low-risk child who has received all scheduled immunization comes in for a 5 year old, preschool check up. What immunizations will be given?
A. Boosters for Hepatitis B and tetanus
B. Boosters for DTaP, IPV, varicella and MMR. Pneumococcal, Hep A series, and meningococcal should be started about this age.
C. New immunization series for MMR and Varicella
D. New immunization series for H. Influenza, polio, and pneumococcal

Lab tests are done to monitor anticoagulant dosing. For which patient would you hold the heparin?
A.     The aPTT is 100 (normal is 25-40 seconds)
B.     The aPTT is 20 (normal is 25-40 seconds).
C.     The INR is 1.8 (normal is 1)
D.     The INR is 0.8 (normal is 1)