MTM Immunization & Preventive Care 3 — Questions and Answers
Question 1: A 16-year-old receives the first dose of HPV vaccine. How many total doses are required and on what schedule?
- 2 doses at 0 and 6-12 months (Correct answer)
- 3 doses at 0, 1-2, and 6 months
- 2 doses at 0 and 4-8 weeks
- 3 doses at 0, 2, and 6 months
Correct answer: 2 doses at 0 and 6-12 months
Individuals starting the HPV series at age 9-14 require only 2 doses given 6-12 months apart; those starting at ≥15 need 3 doses.
Question 2: During an MTM session, a pharmacist identifies a 60-year-old diabetic patient who has never received a hepatitis B vaccine. What is the recommended action?
- Hepatitis B vaccination is not recommended for adults over 59
- Recommend 3-dose hepatitis B series for all unvaccinated adults through age 59, and shared decision-making for age ≥60 (Correct answer)
- Recommend hepatitis B vaccination only if the patient is at high sexual risk
- Order hepatitis B surface antibody testing first to determine need
Correct answer: Recommend 3-dose hepatitis B series for all unvaccinated adults through age 59, and shared decision-making for age ≥60
ACIP recommends universal hepatitis B vaccination for unvaccinated adults aged 19-59; for those ≥60, vaccination is recommended based on shared decision-making or risk factors.
Question 3: Which preventive medication is recommended by USPSTF to reduce fracture risk in postmenopausal women at high risk for osteoporosis?
- Calcium supplementation alone
- Vitamin D supplementation alone
- Low-dose aspirin
- No supplemental benefit has been established by USPSTF for community-dwelling adults (Correct answer)
Correct answer: No supplemental benefit has been established by USPSTF for community-dwelling adults
The USPSTF recommends against vitamin D or calcium supplementation for primary prevention of fractures in community-dwelling adults, as evidence of net benefit is insufficient.
Question 4: A pharmacist reviews a patient's vaccination history and notes MMR vaccination. Which adverse effect should patients be counseled about after MMR vaccination?
- Arthralgia primarily in older women due to the rubella component (Correct answer)
- Severe anaphylaxis in most recipients
- Guillain-Barré syndrome within 24 hours
- Intussusception in adults
Correct answer: Arthralgia primarily in older women due to the rubella component
Joint pain or arthralgia, primarily due to the rubella component of MMR, occurs most commonly in post-pubertal women and is a known adverse effect.
Question 5: What is the USPSTF recommendation for lung cancer screening with low-dose CT (LDCT)?
- Adults 50-80 with ≥20 pack-year history who currently smoke or quit within the past 15 years (Correct answer)
- All current smokers over age 40 regardless of pack-year history
- Adults over 65 with any history of smoking
- Adults with a family history of lung cancer starting at age 45
Correct answer: Adults 50-80 with ≥20 pack-year history who currently smoke or quit within the past 15 years
USPSTF recommends annual LDCT for adults aged 50-80 with a 20+ pack-year smoking history who currently smoke or have quit within the past 15 years.
Question 6: A patient receiving methotrexate for rheumatoid arthritis needs an influenza vaccine. Which formulation is appropriate?
- Live attenuated influenza vaccine (LAIV) is preferred
- Inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) (Correct answer)
- Delay vaccination until methotrexate is discontinued
- High-dose influenza vaccine is contraindicated with methotrexate
Correct answer: Inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV)
Immunocompromised patients on methotrexate should receive inactivated (IIV) or recombinant (RIV) influenza vaccines, not the live LAIV formulation.
Question 7: Which vaccine is specifically recommended for adults traveling to areas where meningococcal disease is endemic, and is also required for Hajj pilgrims?
- MenACWY (meningococcal quadrivalent conjugate vaccine) (Correct answer)
- MenB (serogroup B meningococcal vaccine)
- MPSV4 (meningococcal polysaccharide vaccine)
- MenABCWY combination vaccine only
Correct answer: MenACWY (meningococcal quadrivalent conjugate vaccine)
MenACWY is required for Hajj pilgrims by Saudi Arabian authorities and is recommended for travelers to meningitis belt countries in sub-Saharan Africa.
MTM Immunization & Preventive Care 3
A 16-year-old receives the first dose of HPV vaccine.
How many total doses are required and on what schedule?