Medical History Review

The assignment content discusses various medical topics, including medications, immunization practices, and treatment options. The medication list includes Glipizide, Ibuprofen, Spiriva, and Methotrexate. Folic acid is recommended along with methotrexate to minimize adverse effects. The combination of Methotrexate and Remicade is an effective treatment option for Rheumatoid Arthritis. Standard resources for travel information include the Yellow Book, which provides health information for international travel. Concerning immunization against yellow fever, women who are breastfeeding should not receive the vaccine, and patients with hypersensitivity to gelatin, eggs or chicken products should also avoid the vaccine. Typhoid fever is transmitted through fecal-oral route and can be reduced by vaccination.

Review Questions Name:
Immunology Assignment
1. When should the second dose of the Hepatitis A (Hep A) vaccine be administered?
A. 28 days after the first dose
B. 2 months after the first dose
C. 6 months after the first dose
D. 30 days after the first dose
E. A second dose is not needed
Answer: The correct answer is option C that is 6 months after the first dose and rest all
options are incorrect because there has been a set recommended schedule which consists of 2
doses, in which it is given that the second dose is to be administered 6–18 months after
getting the first dose.
2. KS, a 5-year-old girl, has an appointment today with her pediatrician to receive vaccines.
Her vaccination record shows the following: Hep B at birth, 2 months, and 6 months; RV at
2, 4, and 6 months; DTaP at 2, 4, 6, and 15 months; Hib (ActHIB) at 2, 4, 6, and 15 months;
PCV at 2, 4, 6, and 15 months; IPV at 2, 4, and 6 months; MMR at 15 months; Varicella at
15 months; and Hep A at 15 months. She does not have any medical conditions and is not
allergic to any medications or vaccines. What vaccines should KS receive today?
A. DT, PPSV, IPV, MMR, MCV, and Hep A
B. DTaP, IPV, MMR, Varicella, and Hep A
C. Tdap, IPV, MMR, Varicella, and Hep A
D. DTaP, PPSV, IPV, MMR, Varicella, and Hep A
E. DT, Hepatitis B, MMR, Hepatitis A

Answer: B is correct and rest options are incorrect because accordind to the list prescribed
for 4–6 years, DTaP, MMR, IPV, Varicella are to be given. The MMR vaccine can be given
to babies as young as 6 months old if they will be traveling internationally. These children
should still be given the recommended routine doses at 12–15 months and 4–6 years of age.
3. Which of the following vaccines is only given as a single dose?
A. PCV
B. Zoster
C. RV
D. Td
Answer: option A, is correct and rest are incorrect because it is provided that PCV13 is
recommended as a series of four doses, one dose at each of these ages:
 2 months
 4 months
 6 months
 12 through 15 months
4. Herpes zoster vaccine should be stored at what temperature?
A. ≤ 5° F
B. 6-35° F
C. 36-46° F
D. 47-77° F
Answer: Option c is correct and other are incorrect because it is recommended that

ZOSTAVAX SHOULD BE STORED REFRIGERATED at a temperature of 2 to 8°C (36 to
46°F) or colder until it is reconstituted for injection.
5. Which of the following can safely be given to a 6-month-old child who had an allergic
reaction to the pertussis vaccine?
A. DTaP
B. Tdap
C. Td
D. DT
Answer: option D is correct and others are incorrect because DT is indicated for the
prevention of diphtheria and tetanus in children less than 7 years of age. It does not
contain the pertussis vaccine. It should be used in children who have previously had an
allergic reaction to the pertussis vaccine.
6. EP is pregnant and in her third trimester. Which of the following vaccines can EP
receive? Select all that apply.
A. HPV
B. Hep B
C. MMR
D. Tdap
Answer: d is correct and others are incorrect because Whooping cough is a serious disease
that can be deadly for babies. But babies can't get vaccinated and start building protection
against whooping cough until they are two months old. So to avoid this gap in protection by

getting the whooping cough vaccine (called Tdap) during the third trimester of your
pregnancy. By doing so, you pass antibodies to your baby before birth. These antibodies help
protect your baby in the first few months of life. Pregnant women get the whooping cough
vaccine between 27 and 36 weeks of each pregnancy.
7. LM is an 18-year-old woman who is leaving for her first semester of college next month.
She would like to know what vaccinations she needs before going to college. Her
vaccination record shows the following: DTaP at 2, 4, 6, and 15 months, and 5 years; Hib
(ActHIB) at 2, 4, and 6 months; PCV at 2, 4, 6, and 15 months; IPV at 2, 4, and 6
months, and 5 years; MMR at 15 months and 5 years; Varicella at 15 months and 5 years;
Hep A at 12 and 18 months; Hep B at 11 years, 11 years 2 months, and 11 years 6
months; Tdap at 15 years. LM does not have any medical conditions and is not allergic to
any medications or vaccines. What vaccines should LM receive today?
A. MCV and HPV
B. Tdap, MCV, and HPV
C. Tdap and MCV
D. MPSV and HPV
Answer: option d is correct and others are incorrect because Teens and young adults (16
through 23 year olds) may also be vaccinated with a serogroup B meningococcal vaccine
(2 or 3 doses depending on brand), preferably at 16 through 18 years old. Talk with your
teen’s doctor or nurse about meningococcal vaccination to help protect your child’s
health. MPSV4 is recommended for adults older than 55 who anticipate requiring only a
single dose (travelers, or during community outbreaks).

8. JM, a 6-month-old man is seeing his pediatrician today in order to receive his 6 month
vaccinations. His vaccination records are as follows: Hep B at birth and 2 months; DTaP
at 2 and 4 months; Hib (PedvaxHIB) at 2 and 4 months; PCV at 2 and 4 months; IPV at 2
and 4 months. JM does not have any medical conditions or allergies to medications or
vaccines. Which vaccines should JM receive today?
A. Hep B, RV, DTaP, Hib, PCV, and IPV
B. Hep B, RV, DTaP, PCV, and IPV
C. Hep B, DTaP, Hib, PCV, and IPV
D. Hep B, DTaP, PCV, and IPV
Answer: A is correct option and rest are incorrect because the recommended vaccinations
at the age of 6 months are:
Hepatitis B (Hep B)
Rotavirus (RV)
DTaP (Diphtheria, Tetanus, Pertussis)
Hib (Haemophilus influenzae type b)
Pneumococcal (PCV)
Polio (IPV)
Flu (Influenza) – Yearly starting 6 months
9.An 11-year-old woman fainted after receiving her 11 to 12 year old routine vaccinations.
Which of the following vaccines most likely caused her to faint?
A. Tdap

B. HPV
C. MCV
D. Hep B
Answer: option a, b and c are correct and d is incorrect because it is believed that
Fainting after getting a vaccine is most commonly reported after three vaccines given to
adolescents: HPV, MCV4, and Tdap. Because the ingredients of these three vaccines are
different, yet fainting is seen with all of them, scientists think that fainting is due to the
vaccination process and not to the vaccines themselves.
10. Which of the following diphtheria and tetanus vaccines should be used in adults
as a one-time booster dose?
A. Td
B. DT
C. Tdap
D. DTaP
Answer: option d is correct and others are incorrect because Dtap All children should receive a
series of DTaP at ages 2, 4, and 6 months, with boosters at ages 15-18 months and at 4-6 years.
The fourth dose may be given as early as age 12 months if at least 6 months have elapsed since
the third dose.
11.How should the hepatitis B vaccine (Hep B) be administered?
A. In the deltoid muscle at a 90° angle.

B. In the deltoid muscle at a 45° angle.
C. In the outer-aspect of the triceps at a 45° angle.
D. In the anterolateral thigh at a 45° angle.
Answer: C is correct and others are incorrect because the upper outer triceps of the arm (for
persons 1 year of age and older). If necessary, the upper outer triceps area can be used to
administer subcutaneous injections to infants.
12.TR, a 4-year-old girl, is in the doctor’s office for her 4- to 6-year-old vaccinations. She has
completed her Hep B, Hib, PCV, and Hep A series. She has no medical conditions and is not
allergic to any medications or vaccines. Five days ago she received the live-attenuated influenza
vaccine. Which vaccines should TR receive today?
A. DTaP, IPV, MMR, and Varicella
B. DTaP, PPSV, IPV, and MMR
C. IPV only
D. DTaP and IPV
Answer: A is correct and others are incorrect because the list for 4 year old includes:
DTap (Diphtheria, Tetanus, Pertussis)
Polio (IPV)
MMR (Measles, Mumps, Rubella)
Vericella (Chickenpox)
Flu (Influenza) Yearly starting 6 months
13. A 69-year-old man comes into your pharmacy after receiving a letter advertising your

immunization program. He has diabetes and hypertension and smokes a pack of cigarettes a day.
He does not have any medication or vaccine allergies. His vaccination record shows that he
completed all of his childhood vaccinations (DTaP, Hib, PCV, IPV, and MMR) as well as the
Hep B series, he had the chickenpox when he was 5 years old and received his last Td booster 11
years ago. Which vaccines should this patient receive?
A. Td, Zoster, PPSV, and Hep A
B. Tdap, Varicella, and PPSV
C. Td, Zoster, and PPSV
D. Tdap, Zoster, and PPSV
Answer: A is correct and others are incorrect because PPSV23 is indicated before age 65
(cigarette smokers; patients with chronic heart disease, chronic lung disease, diabetes mellitus,
alcoholism, or chronic liver disease) and Td booster is required every 10 years
14. How should the herpes zoster vaccine (Zoster) be administered?
A. In the deltoid muscle at a 90° angle.
B. In the deltoid muscle at a 45° angle.
C. In the outer-aspect of the triceps at a 45° angle.
D. In the anterolateral thigh at a 45° angle.
Answer: option D is correct and others are incorrect because Subcutaneous injections usually are
administered at a 45-degree angle into the thigh of infants aged <12 months and in the upper-
outer triceps area of persons aged >12 months. Subcutaneous injections can be administered into
the upper-outer triceps area of an infant, if necessary. A 5/8-inch, 23--25-gauge needle should be
inserted into the subcutaneous tissue.

15. A 68-year-old woman patient calls your pharmacy complaining of a rash on the left side of
her midsection. It wraps around her side; however, it doesn’t cross her spine or belly button. She
informs you that it doesn’t itch; however it is very painful. It started to appear two days ago. She
thinks it is shingles and remembers having chickenpox as a child. She would like to know how
she got this infection since she doesn’t remember being around anyone recently who has had
shingles. Which of the following statements should be included in your consultation with her
regarding how she got the herpes zoster infection?
Answer: The varicella zoster virus only causes chickenpox. She had to have come into
contact with another virus that causes shingles. This option is correct and and others are
correct because Shingles, or herpes zoster, is a viral infection caused by the chickenpox virus.
Symptoms include pain and a rash on one side of the body. Shingles most commonly affects
older adults and people with weak immune systems.

Patient Case
FA is a 27 year old female presenting with complaints of fatigue, abdominal pain, non-bloody
diarrhea, and weight loss of 5 kg over the past few months. After meals, she often experiences
nausea and a colicky pain. FA has been taking loperamide which has reduced her diarrhea but
has uncontrolled abdominal pain. Infectious diarrhea has been ruled out and it is determined
that FA has Crohn’s disease.
Allergies: NKDA
Social History: Drinks 5 to 6 beers every weekend Smokes 1 pack of cigarettes daily
Family History: Mother has Crohn’s disease
Past Medical Problems: Acid Reflux, Chronic Back Pain
Medication List:
Tums 500 mg PO three times daily after meals
Loperamide 2 mg PO three times daily
Naproxen 500 mg PO twice daily PRN (uses twice a day consistently)
Labs:
Hgb 14.2 g/dL SCr 0.9 mg/dL
16. Which if the following factors may worsen FA’s Crohn’s symptoms? (Select ALL that
apply)
A. Taking Loperamide
B. Taking Naproxen
C. Smoking
D. Drinking Alcohol
Answer: D is correct and other incorrect beause Certain things can affect the severity of your
symptoms. This includes:
 whether you smoke
 your age
 your stress levels

17. FA tells you that her physician recommended she start taking a multivitamin as Crohn’s can
affect her body’s absorption of vitamins. Which of the following vitamins/nutrients would you
NOT recommend she supplement?
A. Vitamin D
B. Vitamin A
C. Calcium
D. Vitamin B-12
E. Phosphorus
Answer: C is correct answer and others are incorrect because the one exception is that
vitamin B12. Caffeine stimulates the production of stomach acid, which actually helps the body
absorb B12.
18. FA’s physician decides to treat her Crohn’s with an aminosalicylate. Which of the following is
not classified as an aminosalicylate?
A. Canasa
B. Lialda
C. Balsalazide
D. Azathioprine
E. Asacol
Answer: C is correct
19. FA’s physician has prescribed sulfasalazine. FA should be counseled on which of the
following side effects associated with this therapy?
A. Temporary infertility
B. Inhibited folate absorption
C. Constipation
D. Blurred vision
E. Hair loss
C is correct as most common medical conditions indicated by the symptoms blurred vision,
difficulty finding words, dizziness and hair loss including Middle ear infection, Labyrinthitis,
and Transient ischemic attack (mini-stroke).
20. FA develops a rash after taking sulfasalazine for 4 days. Which of the following statements

is true?
A. Those with sulfa allergies may have a reaction to the sulfapyridine component of
sulfasalazine.
B. Mesalamine also contains sulfapyridine and 5-aminosalicylic acid.
C. Mesalamine is not tolerated as well as sulfasalazine.
D. Anti-TNF antibodies and similar biologics are contraindicated in those who do not tolerate
aminosalicylate therapy.
21. Place the following corticosteroids in order of DECREASING potency.
A. Prednisone
B. Methylprednisolone
C. Hydrocortisone
D. Dexamethasone
Answer; D, a, b ,c is correct order because Short-acting products such as hydrocortisone are
the least potent. Prednisone and methylprednisolone, which are intermediate-acting products,
are four to five times more potent than hydrocortisone. Dexamethasone is a long-acting,
systemic corticosteroid; its potency is about 25 times greater than the short-acting products
Patient Case
FH is a 54 year old female who was recently diagnosed with Rheumatoid Arthritis and the
provider will be initiating therapy today.
Past Medical History: COPD
Diabetes Mellitus Type II
Medication List:
Glipizide 5 mg daily
Ibuprofen 600 mg every 8 hours PRN Spiriva 18 mcg daily
22. Which of the following best describes why folic acid is recommended along with
methotrexate?
A. Methotrexate inhibits dihydrofolate reductase, depleting folic acid supplies
B. Methotrexate agonizes dihydrofolate reductase, depleting folic acid stores
C. Folic Acid enhances Methotrexates therapeutic efficacy
D. Folic Acid decreases the concentration of methotrexate metabolites, reducing methotrexate
toxicity
Answer: D is correct because Adverse effects of low-dose MTX in patients with RA are related
to folate antagonism and/or folate deficiency. Folate supplementation, in the form of folic acid or
folinic acid, is often coadministered with MTX to minimize adverse effects (eg, stomatitis,
gastrointestinal intolerance, bone marrow toxicity, and abnormal liver function tests).[1]
Studies have examined the effectiveness of folate supplementation in decreasing adverse
effects associated with low-dose MTX. A Cochrane Review evaluated 7 randomized, double-
blind, placebo-controlled trials that assessed whether folinic acid or folic acid decreased side
effects of MTX in patients with RA. Both folinic acid and folic acid were found to decrease
gastrointestinal and mucosal side effects. The use of folinic acid, however, may not be cost-
effective unless pharmacoeconomics studies find it to be more clinically effective than the less
expensive folic acid.
23. The provider has just prescribed Methotrexate and Remicade for the treatment of the FH’s
Rheumatoid Arthritis. Which of the following is/are true about these medications?

A. These medications should not be used in combination due to drug-drug interactions
B. Remicade can be used as monotherapy or add-on therapy to Methotrexate
C. LFT’s should be monitored closely for hepatotoxicity with concurrent use
D. Both of these medications are Pregnancy category X medications
Answer: B is correct because systematic review and Bayesian random effects network meta-
analysis of trials assessing methotrexate used alone or in combination with other conventional
synthetic DMARDs, biologic drugs, or tofacitinib in adult patients with rheumatoid arthritis
24. Which of the following is a standard resource for travel information that was compiled as a
reference by CDC?
A. The Pink Book
B. The Yellow Book
C. The Pink Sheet
D. The Orange Book
E. The Red Book
Answer: B is correct because The new edition of the Yellow Book, a health information tool for
international travel published by the Centers for Disease Control and Prevention and considered
by many to be the gold standard on travel information, has been expanded to offer new
information on scuba diving safety, high altitude travel, travelers with special needs, and
traveling with children.
The Yellow Book also offers vaccination and medication information for disease risks by
destination as well as helpful health hints for cruise ship travel, international adoptions, motion
sickness and much more.
25. Which of the following is recommended by the Advisory Committee on Immunization
Practices concerning immunization against yellow fever with YF-VAX? (Select ALL that apply)
A. Women who are breastfeeding should not receive the vaccine
B. Patients with hypersensitivity to gelatin, eggs or chicken products should not receive this
vaccine.
C. Patients who are taking Enbrel or Humira should not receive the vaccine
D. Patients on high-dose corticosteroid inhaler for asthma should not receive this vaccine
E. Patients who are taking prednisone should not receive the vaccine.
Answer: A is correct because vaccination of nursing mothers should be avoided because of the
theoretical risk for the transmission of 17D virus to the breast-fed infant.
B is also correct because elatin is used as a stabilizer in different vaccines, including yellow
fever vaccine. Gelatin has been implicated as a cause of allergic reaction related to other
vaccines and, therefore, might also do the same regarding yellow fever vaccine
26. A patient developed typhoid fever while traveling in Southeast Asia. Which of the following is
true of typhoid fever? (Select ALL that apply)

A. It is transmitted by ticks
B. Vaccination can reduce risk of transmission
C. It is transmitted through fecal-oral route
D. It cannot be treated with antibiotics
E. It is transmitted by mosquitos
Answer: A and e are correct because Mosquitos and ticks may carry an infectious agent through
purely mechanical means or may support growth or changes in the agent