Dose of Tetanus Immune Globulin (TIG) - Answer-250 units IM
/.How many doses of Tdap or Td IM needed for protection after clean minor wounds. -
Answer-Three doses needed. If <3, unknown, or >10 years since last dose give dose of
Tdap or Td for clean minor wounds. No need to give TIG.
/.Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of
Tdap/Td. - Answer-Tdap or Td IM & TIG
/.Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles, burns,
frostbite) - Answer-If <3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses
in past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or >
doses in the past
/.When to switch from DTap to Tdap in children - Answer-Age 7 or > given Tdap
/.A woman becomes pregnant and received Tdap during her last pregnancy 1 year ago.
When should she receive her next dose. - Answer-Tdap is recommended for each
pregnancy.
"Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
/.A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)?
- Answer-IPV, MMR, varicella
/.A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)?
- Answer-IPV, vaccinia (smallpox)
/.A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations
(IZ)? - Answer-Hepatitis B
/.A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? -
Answer-varicella zoster (zostavax) and MMR
/.Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What
other interventions/meds should be considered during anaphylaxis? - Answer-Supine,
911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
, >30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
/.s/s anaphylaxis - Answer-Skin: pruritus, urticaria, angioedema
Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
/.PCV-13 - Answer-Prevnar. Greater protection, Narrower coverage. Pneumococcal
conjugate.
/.PCV23 - Answer-lesser protection, broader coverage
/.Which type of vaccine boosts immune response better? conjugate vs. polysaccharide -
Answer-conjugate (example: prevnar)
/.Live attenuated (weaned) vaccines - Answer-MMR, Varicella and intranasal Flu-mist.
Zostavax is also live. Shingrix is NOT live.
/.When is rotavirus vaccine contraindicated? - Answer-SCID (severe combined
immunodeficiency) or hx intussusception
/.Precautions after rotavirus - Answer-hand washing!; viral shed in stool in first week
post-vaccination
/.Shingrix: timing and dosing - Answer-=/> 50 y/o, 2 doses, 2nd dose two to six months
after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
/.What month does the CDC release a new vaccination schedule each year? - Answer-
Feb
/.What s/s are associated with leukemia? - Answer-fever, wt loss, fatigue, bone pain,
bleeding, bruising.
/.What bloodwork should be obtained in suspected leukemia? - Answer-WBCs >20,000
(think through common causes of leukocytosis: infection, stress, inflammation) --> get a
peripheral smear (AKA manual diff)
/.How many doses of Tdap or Td IM needed for protection after clean minor wounds. -
Answer-Three doses needed. If <3, unknown, or >10 years since last dose give dose of
Tdap or Td for clean minor wounds. No need to give TIG.
/.Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of
Tdap/Td. - Answer-Tdap or Td IM & TIG
/.Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles, burns,
frostbite) - Answer-If <3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses
in past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or >
doses in the past
/.When to switch from DTap to Tdap in children - Answer-Age 7 or > given Tdap
/.A woman becomes pregnant and received Tdap during her last pregnancy 1 year ago.
When should she receive her next dose. - Answer-Tdap is recommended for each
pregnancy.
"Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
/.A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)?
- Answer-IPV, MMR, varicella
/.A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)?
- Answer-IPV, vaccinia (smallpox)
/.A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations
(IZ)? - Answer-Hepatitis B
/.A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? -
Answer-varicella zoster (zostavax) and MMR
/.Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What
other interventions/meds should be considered during anaphylaxis? - Answer-Supine,
911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
, >30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
/.s/s anaphylaxis - Answer-Skin: pruritus, urticaria, angioedema
Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
/.PCV-13 - Answer-Prevnar. Greater protection, Narrower coverage. Pneumococcal
conjugate.
/.PCV23 - Answer-lesser protection, broader coverage
/.Which type of vaccine boosts immune response better? conjugate vs. polysaccharide -
Answer-conjugate (example: prevnar)
/.Live attenuated (weaned) vaccines - Answer-MMR, Varicella and intranasal Flu-mist.
Zostavax is also live. Shingrix is NOT live.
/.When is rotavirus vaccine contraindicated? - Answer-SCID (severe combined
immunodeficiency) or hx intussusception
/.Precautions after rotavirus - Answer-hand washing!; viral shed in stool in first week
post-vaccination
/.Shingrix: timing and dosing - Answer-=/> 50 y/o, 2 doses, 2nd dose two to six months
after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
/.What month does the CDC release a new vaccination schedule each year? - Answer-
Feb
/.What s/s are associated with leukemia? - Answer-fever, wt loss, fatigue, bone pain,
bleeding, bruising.
/.What bloodwork should be obtained in suspected leukemia? - Answer-WBCs >20,000
(think through common causes of leukocytosis: infection, stress, inflammation) --> get a
peripheral smear (AKA manual diff)
