MTM Immunization & Preventive Care 2 — Questions and Answers
Question 1: A 65-year-old patient asks about the recombinant zoster vaccine (RZV, Shingrix). Which statement is correct?
- One dose is sufficient for adults ≥50 years
- Two doses are given 2-6 months apart (Correct answer)
- It is contraindicated in immunocompromised patients
- It should not be given if the patient had zoster in the past year
Correct answer: Two doses are given 2-6 months apart
RZV (Shingrix) requires two doses administered 2-6 months apart (or 1-2 months apart in immunocompromised patients).
Question 2: Which preventive service is recommended annually for adults aged 50 and older by USPSTF based on colorectal cancer screening guidelines?
- Colonoscopy
- Fecal immunochemical test (FIT) (Correct answer)
- CT colonography
- Flexible sigmoidoscopy
Correct answer: Fecal immunochemical test (FIT)
Annual high-sensitivity FIT is one of the recommended colorectal cancer screening options for adults aged 45-75, making it the only annually repeated stool-based test.
Question 3: A 28-year-old pregnant patient in her first trimester asks about Tdap vaccination. What is the correct guidance?
- Tdap should be given in the first trimester for maximum maternal protection
- Tdap is contraindicated during pregnancy
- Tdap is recommended at 27-36 weeks gestation with each pregnancy (Correct answer)
- Tdap should be deferred until after delivery
Correct answer: Tdap is recommended at 27-36 weeks gestation with each pregnancy
Tdap is recommended during 27-36 weeks of each pregnancy to maximize passive antibody transfer to the newborn and protect against pertussis.
Question 4: An MTM pharmacist reviews a 45-year-old HIV-positive patient's immunization record. Which vaccine is CONTRAINDICATED in this patient?
- Inactivated influenza vaccine (IIV)
- Recombinant zoster vaccine (RZV)
- Pneumococcal conjugate vaccine (PCV15)
- Live attenuated influenza vaccine (LAIV) (Correct answer)
Correct answer: Live attenuated influenza vaccine (LAIV)
LAIV (FluMist) is a live attenuated vaccine contraindicated in immunocompromised patients including those with HIV infection.
Question 5: According to USPSTF guidelines, at what age should breast cancer screening with mammography begin for women at average risk?
- Age 40 (Correct answer)
- Age 45
- Age 50
- Age 55
Correct answer: Age 40
The 2024 USPSTF update recommends biennial mammography screening starting at age 40 for women at average risk.
Question 6: A patient taking long-term high-dose corticosteroids (prednisone 20 mg/day for >14 days) needs vaccination. Which vaccine requires special consideration?
- Hepatitis B vaccine
- Pneumococcal vaccine
- Live vaccines such as MMR and varicella (Correct answer)
- Inactivated influenza vaccine
Correct answer: Live vaccines such as MMR and varicella
High-dose corticosteroids (≥20 mg/day of prednisone for ≥14 days) cause immunosuppression, contraindicating live vaccines like MMR and varicella.
Question 7: Which of the following patients has the HIGHEST priority for receiving pneumococcal vaccination with both PCV20 and PPSV23?
- A healthy 65-year-old woman
- A 55-year-old with well-controlled hypertension
- A 40-year-old with asplenia (Correct answer)
- A 70-year-old who received PPSV23 at age 65
Correct answer: A 40-year-old with asplenia
Patients with functional or anatomic asplenia are at highest risk for invasive pneumococcal disease and need pneumococcal vaccination regardless of age.
MTM Immunization & Preventive Care 2
A 65-year-old patient asks about the recombinant zoster vaccine (RZV, Shingrix).
Which statement is correct?