REVISION 1

QUESTION 1
● How to give hepatitis B vaccine
● A-Intradermal
● B-Subcutanous
● C-Intramuscular
● D-Nasal
● As general rules
● Live vaccines: subcutanous
● Killed vaccines: intramusular
● BCG: intradermal
● Oral: polio , rota
● A child came for vaccinations , his brother known for
immunodeficiency , which of the following vaccines
should be postponed
● A-IPV
● B-Varicella
● C-DTaP
● D-hepatitis A
● Live attenuated vaccines should not be given in
children with immunodeficiency
● Should be delayed in children with known family
history of immunodeficiency till the evaluation done
for the child
● BCG
● MMR
● Varicella
● Oral polio
● Rota
● Nasal influenza
● Yellow fever
● Typhoid
● Plague
● All viral vaccines are live attenuated excpet (HI HI)
● Hepatitis B and inactive polio , Hepatitis A and
inactive influenza

● All bacterial vaccine are killed vaccines except TB (

BCG and typhoid )
● Live attenuated vaccines are generally contraindicated
in immunocompromised patients
 QUESTION 3
● 12-month-old and supposed to have a scheduled
vaccine. He had mild diarrhea . What you will do?
● A-Delay the vaccine
● B-Obtain a bacterial culture
● C-Give the vaccine
● D-Start antibiotic
● Mild febrile illness or mid dehydration are not
contraindications for vaccines
● 4 years old child and has URTI and started on
antibiotic for 4 days. He came today and found to have
enlarged lymph nodes and congested throat. He is
scheduled for vaccine today
You should
A-Delay the vaccine for 1 month
B-Let him finish the antibiotic and then give the vaccine
C-Give the vaccine
D-Ask another opinion
● According to CDC guidelines
● Antibiotic does not interfere with efficacy of vaccine
and children can take the vaccine while on antibiotic if
clinically stable
 QUESTION 5
● baby born on 35th week of gestation. his mother bring
him for vaccination. which of the following is true?!
● A) give the vaccine at time as schedule
● B) delay his vaccination 2 months
● C) give vaccine at time, but half the dose
● D)Consult infectious disease doctor
● Preterm baby should received the vaccine at actual age
not the corrected age
 QUESTION 6
● which vaccine is contraindicated in HIV pt
● A. OPV
● B. varicella
● C. MMR
● D-DTP
● HIV patient can receive live vaccines if
● 1-Asymptompatic
● 2-CD4 percentage is ore than 15 % in children less
than 5 years
● 3-If CD4 count is more than 200 cell/microl in
children above 5 years

● Oral polio and BCG are absolute contraindicated in

HIV patients
● DtAP vaccines
● Killed vaccine
● Protects against
● Diphtheria , pertussis , Tetanus
● Furation for pertussis vaccine 10 years
 QUESTION 8
● Which of the following is an absolute contraindication
to DTP vaccine
● A- History of anaphylaxis to previous DTP vaccine
● B- Crying for 3 hours
● C- Controlled convulsion
● D-Mild URTI
 ● As a rule of thump
● Any history of analphylaxis to a vaccine is a
contraindication to that vaccine

DtAP vaccine efficacy

duration is 10 years
● Patient develop anaphylaxis to vaccination at 4-month
schedule, Best actions
● A- Wait for allergy screening
● B-Defer Hib
● C-Defer hep B
● D-Defer DtAP
● It would be wise to known which vaccines that patient
has allergy or anaphylaxis before giving the vaccine
● A baby born recently. His brother died because of
immunodeficiency
● Best action
● A-Consult an immunologist
● B-Defer live attenuated vaccines (correct answer if
there is no immunologist in the hospital)
● C-Defer killed vaccine
● D-Defer all vaccines
● In general
● If there is child s family history for immunodeficiency,
then this child should have an assessment for immune
system before giving live attenuated vaccines
● 14 years old girl and never vaccinated. She wants to
take varicella vaccine
● Best action
● A-No need for varicella vaccine
● B-Only one dose
● C-2 doses with 4 weeks a part
● D-2 doses with 6 months aprt
● Varicella vaccines
● Live attenuated vaccines
● Given at
● 18 months
● 4-6 years
Contraindications to varicella
vaccine
● Has a history of anaphylactic/anaphylactoid
reaction to gelatin, neomycin, or any other
component of the vaccine
● has blood dyscrasias, leukemia, lymphomas, or
malignant neoplasms affecting bone marrow or the
lymphatic system
● has a primary or acquired immunodeficiency,
including persons with immunosuppression associated
with cellular immunodeficiencies and AIDS or severe
immunosuppression associated with HIV infection
Contraindications to live
vaccines
● is receiving prolonged, high-dose systemic
immunosuppressive therapy (≥2 weeks), including large
doses of oral steroids (≥2mg/kg of body weight or a total of
20mg/day of prednisone or its equivalent for people who
weigh >10kg) or other immunosuppressive therapy
● has a moderate or severe concurrent illness
● has received blood products (such as whole blood,
plasma, or immune globulin) during the previous 3 to 11
months, depending on dosage
● has a family history (first degree relatives) of congenital
hereditary immunodeficiency, unless the person has been
determined to be immunocompetent
Contraindications to live vaccines
Catch up schedule for chicken pox
vaccine
● In children less that 7 years: 2 doses with 3 months
apart
● In children above 7 years: 2 doses with 4 weeks aprt
● Which of the following vaccine is a contraindicated in
patients with egg allergy
● A-MMR
● B-Yellow fever vaccine
● C-Varicella
● D-flu vaccine
Contraindications for yellow fever
vaccine
● Egg
● Chicken protein
● Gelatin
 CDC guidelines
● For persons with a history of minor reactions to eggs
or other vaccine components, consider skin testing to
check for reactivity before administering the vaccine. *

● If vaccination is essential because of travel to a high-

risk area and patient has a history of severe egg
sensitivity, or has a positive skin test to the vaccine,
refer to an allergist for consideration of
desensitization.
● 30 years old pregnant and known inflammatory bowel
disease and taking anti TNF and azathioprine
● Regarding the vaccination for her bay
● A-Give all the vaccine on schedule
● B-Delay the killed vaccine
● C-Delay the live vaccines for 3 months
● D-Delay the live vaccine for 6 months
● If a pregnant taking biological agents like anti-TNF in
the 2nd trimester, then live vaccines for her baby
should be delayed for 6 months
● If she took it in 3rd trimester then live vaccines
should be delayed for 12 months
● SLE mother and she delivered a baby girl
● For her baby you should
● A-Give Hepatitis B
● B-Give BCG (delay for 6 months)
● C-Give both
● D-Don’t give anyhting
● Just remember
● Hepatitis B vaccine is a killed vaccine and can be given
safely in babies delivered to mother taking biological
agents
● Remember that BCG vaccine according to new saudi
schedule should be given at 6 months
● Patient known Severe combined immunodeficiency
● Which of the following vaccine can be given safely to
him
● A-All the vaccines
● B-Only live vaccines
● C-Only killed vaccine
● D-No vaccine
● Patients with severe combined deficiency
● or
● T cell disease like digeorge syndrome
● or
● Humoral immunity should not receive live attenuated
vaccines viral or bacterial live vaccines)
● Patient known X linked aggamamglubminema
● Which vaccines can be given to him

● A-DTaP
● B-MMR
● C-varicella
● D-BCG
● Patients with defect in humoral immunity like X
linked aggamglublmemia can receive killed vaccines
only
● Patients with mild types of humroal immunity disease
like IgA deficiency or IgG subclass deficiency cab
receive live and killed vaccines
● Patient known with chronic granulomatosis disease
● Which vaccine is contraindicated
● A-Typhoid (bacterial)
● B-MMR (viral)
● C-Hepaitits A
● D-DtAP
Chronic granulomatosis disease
● Phagocyte disease
● Should not receive bacterial live vaccines (BCG ,
typhoid, plague)
● Patient known with complement deficiency
● Which vaccine he can receive?
● A-All types of vaccines
● B-Only killed vaccine
● C-Only live vaccines
● D-No vaccine
● Patients with complement deficiency can receive any
vaccines (live or killed )
● In fact, nesseria vaccines in very important to be given
in patients with complement deficiency
● 5 years old child and unvaccinated. He came with
fever , skin rash started from face and sprat to the
chest and trunk. He has enlarged occipital , post
auricular and posterior cervical lymph node
● This disease can be prevented by series of vaccines
given at:
● A-2, 4 , 6 months
● B-9 , 12 , 18 months
● C-12 , 18 months and 4 years
● D-This disease is not preventable

This disease is German measles (rubella)

● In Saudi Arabia. The policy of vaccine to prevent
● A-Q fever
● B- Japanese encephalitis
● C-Herpes encephalitis
● D-Hemophilis influnza meningitis
● An infant known with history of intusspession
● Which vaccine is contraindicated
● A-BCG
● B-Rota
● C-MMR
● D-Varicella
● Rotal virus known to cause acute gastroenteritis in
infants
● In the past Rota vaccine known to cause inuusspestion
● But with new version of rotal vaccine inusspession
reduced significantly
● However history of inussepsion is a contrainidation for
Rotal vaccine
● Which of the following allergy is contraindications for
varicella vaccines
● A-Egg allergy
● B- penicillin allergy
● C-Gentamycin allergy
● D-gelatin allergy
Contraindications for live
attenuated vaccines
● Immunodeficncey
● History of recent blood transfusion , blood products or
immunoglobuloin
● Pregnancy
● If received another live vaccines 4 weeks ago
● Anaphylaxis to the vaccine
● Allergy to neomycin or gelatin are contraindications to
MMR and varicella
 QUESTION 10
● One month boy came for vaccine. His older sister
(6 years old) had renal transplant and now is on
immunosuppressive medication. Which vaccine is
contraindicated for the boy?
● a- MMR
● b- Oral polio
● c- Salk polio
● d- Influenza

● Oral polio vaccine can be disseminated by fecal-oral

route to other individual (herd immunity )
 QUESTION 14
● 5 years old and known leukemia and chemotherapy
syndrome on steroid for 6 weeks and came to you. He
had a contact with a patient with chicken pox
● What you do for him?
● A-Nothing
● B- Varicella zoster immunoglobulin
● C-Admit him to the hospital
● D-Give him varicella vaccine

● In any immunosupressed patients with a contact with

chicken pox should receive varicella zoster
immunoglobulin
● A mother known HIV and delivered a baby
● Which vaccine you will give at birth
● A-BCG and hepatitis B
● B-Hepatitis B
● C-BCG
● D-None
● baby with recurrent infection TB, aspergillosis all
type of infection with history of brothers death at
3 year with same pt give?
● A. Influenza
● B. BCG A and D are correct, but A is more
important in the immunodeficiency patients
● C. Varicella
● D. Inactivated Polio
● With the exception for infants under 6 months
● Flue vaccines should be given annually to all children
● Particularly, in children below 5 years
● Exposed or living with healthcare workers
● Chronic illness
● Immunodeficiency
● patient can't take BCG vaccine Because he
deficiency in
● A. IL
● B. TNF gama
● C. INF gama
● D-CD19
● If the patient has defects in innate immunity
● Defects in interferon pathway (Alpha or gamma): no
live viral or live bacterial vaccines

● Defects in IL-12 pathways: no live bacterail vaccines

● 3 years old boy came with fever and meningeal signs ,
petechial rash
● Which of the following can prevent this condition
● A- series of vaccine started at 2 months
● B-Series of vaccine started at age of 9 months
● C-Vaccine at birth
● D-Nothing will prevent this condition
● Which of following can happen years ago after
measles vaccine
● A-Gullian barre syndrome
● B-Spastic paraplegia
● C-Brain tumor
● D-Subacute scelrosing panencephalitis
● Which vaccine related to gullian barre sybdrome
● A-MMR
● B-Nesseria
● C-Flu vaccine
● D-Hepatitis B
 QUESTION 15
● 2 years old and known SCA and scheduled for
splenctomy
● Which of following vaccine is the most important
● A-DTP
● B-Hepatitis B
● C-Menigiococcus
● D-Varcella
 QUESTION 18
● Patient is known nephrotic syndrome and he finished
steroid just now and wants MMR vaccine
● What you will do
● A-No vaccines
● B-Give the vaccine
● C-Ask her to come back after 4 weeks
● D-Ask her to come back after 7 weeks
Live vaccines vs steroids
● 4 weeks after stopping steroid
● 12 weeks after stopping other types of chemotherapy
● No live or killed vaccines after rituximab treatment for
6 months
● Oral steroid for less than 2 weeks
● Inhaled steroid
● Topical steroid
● Are not contraindications for live vaccines
● Oral steroid cause immunosupression only if given
more than 2 weeks with a dose of 2 mg/kg per day
 QUESTION 19
● 6 years old girl and she received intravenous
immunoglobulin because of Kawasaki disease last week
● Which of the following vaccine should be delayed?
● A-Injectable flue
● B-DTaP
● C-MMR
● D-Pneumococcal vaccines
● Live Vaccine show be delayed (epsecailly MMR or
varicella)
● 3-11 month after IVIG , blood produts (Fresh frozen
plasma , PRBC or platelets )
● Known SCA and received blood transfusion 3 weeks
ago
● Now he came for his hepatitis A vaccine
● You should
● A-Give the vaccine
● B-ask him to come after 3 months
● C-Ask him to come after 6 months
● D-Ask him to come after 9 months
● Recent blood transfusion is not a reason to delay killed
vaccine like hepatitis A
 QUESTION 20
● Known case of cystic fibrosis with recurrent chest
infections
● Most important vaccine
● A-DTP
● B-Hemophilus
● C-MMR
● D-Pneuomococcus
Patient with chronic respiratory
disorder should receive
●Influenza
●Pneumococcal
● 4 years old came with URTI , high fever , drooling of
saliva and multiple enlarged lymph node. He did not
receive any vaccine
● Which of following vaccine might prevent this condition?
● A-Hemophlius
● B-Streptococcus
● C-Diphteria
● D-Polio
● A child with immunodeficiency
● Which vaccines is the safest:
● A-Rota
● B-MMT
● C-Varicella
● D-Nasal influnza

● With the exception severe combined immunodeficiency

● Rota virus appears to be safe in other forms of immunodeficiency
● A mother brought her 6 months old child for DTaP
vaccines, he has febrile convulsion due to DTaP
vaccine
● Best actions:
● A-Tell her he needs the vaccine regardless type of
reaction
● B-Postpone for 3 months
● C-Febrile seizure is not a contraindication for
DTaP vaccines
● D-He should not receive the vaccine
Absolute contraindication for DTaP
vaccines
● History of anaphylaxis to previous DTaP dose
● Uncontrolled CNS condition
● Encephalopathy within 7 days from previous DTaP
dose
● High fever or severe acute illness (delay till the child is
doing well )
Precautions to DTaP
● Febrile seizures after previous DTaP
● History of crying or high fever or febrile seizures from
previous DTaP
● History of gullian barre syndrome within 6 weeks of
previous DTaP
● A child has splenic rupture and will go for splenectomy
● Which vaccines is the most important?
● A-DTaP
● B-Varecilla
● C-Pneumococcal vaccines
● D-Menigococcus

● Both pneumococcal and meningococcal vaccine are important in

patients with splenectomy
● I choose pneumococcal because it is more common
● 18 months old came for vaccination and received IVIG
one month ago.
● What should you give?
● A-DTP
● B-OPV
● C-MMR
● D-varicella
● Vaccine for 9 months old
● A-DTaP , HiB , Oral polio
● B-Meniniogococcus , measles
● C-MMR , Meningiococcus
● D-Pneucoccal , Hepatits B
● Best way to prevent tetanus neontaarum
● A-Give vaccine to mother after 72 hours ofdelivery
● B-Give infant tetanus toxoid
● C-Give infant DTaP
● Best way to prevent tetanus neonatorum
● A-Give vaccine to mother after 72 hours of delivery
● B-Give infant tetanus toxoid
● C-Give infant DTaP
● Best way to prevent tetanus neontatrum is to vaccine
the mother
● CDC recommends that pregnant women should
receive a single dose of DTaP between 27 to 36 weeks
● Bit after deliver DTaP to the mother have no effect to
babies
● It can 2 weeks for babies to develop antibodies if
mother vaccinated during pregnancy
The rest was skipped
by the doctor
● How to decrease asthma excrcebration
● A-Receive influnza virus vaccines
● B-Carpteing the bed and play area
● C-Change the humidity
● How to decrease asthma excrcebration
● A-Receive influenza virus vaccines
● B-Carpteing the bed and play area
● C-Change the humidity
● breast feeding mother known history of seizure
with phenytoin ask about breast feed ?
● A. Reassurance
● B. feeding after 8 hrs
● C-No breast feeding
● D-Check phenytoin level
● Patient known cancer and just finished his
chemotherapy
● Mother asked when to give MMR vaccine
● A-Now
● B-After 3 months
● C-After 6 months
● D-After 12 months
● Patient known cancer and just finished his
chemotherapy
● Mother asked when to give MMR vaccine
● A-Now
● B-After 3 months
● C-After 6 months
● D-After 12 months
● If patient planned for chemotherpy
● He should take the vaccines 2 weeks before chemo and
6 months after chemotherapy
● which situation the hepatitis c positive mother
should not breastfed her infant ;
● A- Lack of hepatitis c vaccine
● B- Cracked nipples
● C-vaginal discharge
● D-Malnutrition
● which situation the hepatitis c positive mother
should not breastfed her infant ;
● A- Lack of hepatitis c vaccine
● B- Cracked nipples
● C-vaginal discharge
● D-Malnutrition
● Its not safe to breastfeed the baby if mother is HIV or
hepatitis positive with cracked nipple
● Best antibiotic for breast feeding is ?
● A- Chloramphenicol
● B- Azithromycin
● C- Cimetidine
● D- Ciprofloxacin
● Best antibiotic for breast feeding is ?
● A- Chloramphenicol
● B- Azithromycin
● C- Cimetidine
● D- Ciprofloxacin
QUESTION 27
A child swallowed his Carbamazepine. What is
the best way of gastric decontamination?
• a) Gastric lavage
• b) Total bowel irrigation (whole bowel wash)
• c) Syrup ipecac
• d) Activated charcoal
QUESTION 27
A child swallowed his Carbamazepine. What is
the best way of gastric decontamination?
• a) Gastric lavage
• b) Total bowel irrigation (whole bowel wash)
• c) Syrup ipecac
• d) Activated charcoal
 V.IMP

GASTRIC DECTAMINATION
-Ipecac (INDUCE VOMITING) NOT USED ANYNORE
-Charcoal: Method of choice for most posion
-WHOLE BOWEL IRRIGATON: Used for IRON,
lithium
-GASTRIC ASPIRATION: USED FOR REMOVING OF
FLUID
V.IMP

Total bowel irrigation

QUESTION 28
Patient presented to the ER with diarrhea, nausea,
vomiting, salivation, lacrimation and abdominal
cramps. What do you suspect?
• a) Organophosphate poisoning
• B)Paracetamol poisoning
• C) Aspirin
• D)Peniciln
QUESTION 28
Patient presented to the ER with diarrhea, nausea,
vomiting, salivation, lacrimation and abdominal
cramps. What do you suspect?
• a) Organophosphate poisoning
• B)Paracetamol poisoning
• C) Aspirin
• D)Peniciln
 QUESTION 28
V.IMP

common toxicity symptoms:

● Organophosphate: Cholenergic manifestations
= (Lacrimation, salivation, miosis, cramp)
● Paracetamol: liver
● Narcotics: misosis, respiratory depression
● Tricyclic antidepressent: Dry mouth, dry eye convulsion
● Aspirin: Nausea, vomiting, tinnitus, headache, confusion,
hyperventilation, tachycardia, fever,metabolic acidosis
• Alcohol: acidosis, Liver failure, deliurum, blindness (methanol)
QUESTION 29
What is the antidote for aspirin:
• A-N-acetycystine
• B-Sodium bicarbonate
• C-Naloxone
• D-Flumazeni
QUESTION 29
What is the antidote for aspirin:
• A-N-acetycystine
• B-Sodium bicarbonate
• C-Naloxone
• D-Flumazeni
 V.IMP
QUESTION 29
Common antidotes:

• Organiposphate: atropine
• Narcotics: Naloxone
• Benzodiazpine: Flumazenil
• Paracetamol: N0acetylcystine
• Aspirin: NaHCO3
• Methnol: ethanol, fomepizole
• TCA: Sodium bicarbonate
● 3 years old girl brought to you for routine evaluation her
weight was below the 3rd percentile. The likely cause of
her poor weight gain is:
●
● Hypopituitarism
● TORCH infections
● Inadequate caloric intake
● Hypothyroidism
● Celiac disease
● 3 years old girl brought to you for routine evaluation her
weight was below the 3rd percentile. The likely cause of
her poor weight gain is:
●
● Hypopituitarism
● TORCH infections
● Inadequate caloric intake
● Hypothyroidism
● Celiac disease
QUESTION 21
Cow milk differ from mature human milk that
human milk contain more:
• a) More protein
• B)Protected antibodies
• c) More calories
• d) More fat
QUESTION 21
Cow milk differ from mature human milk that
human milk contain more:
• a) More protein
• B)Protected antibodies
• c) More calories
• d) More fat
● What is more present in Cow milk than breast
milk
● A-proteins
● B-fat
● C-carbs
● D-calories
● What is more present in Cow milk than breast
milk
● A-proteins
● B-fat
● C-carbs
● D-calories
● Cow milk contains more
● Protein
● Iron (but less bioavailable than human milk)

● Human mlik contains more

● Carbohydrate
● More antibodies

● Both contains same amount of fat (human milk more essential

fatty acid and
● Both contains same calories (67 calories/100 ml)
 GROWTH CURVES
● Most important factors control of the growth
● First 2 years: nutrition
● From 2 years to adolescent : Growth hormone and
thyroid hormones
● At adolescent : Sex hromones
 GROWTH CURVES
● Fist 2 steps in any growth curve
● Growth velocity (normal is 5 cm per year)
● Calculate mid parental height
● Normal growth velocity (5 cm per year)
● Physiological
● 1-Familial
● 2-Consitituional delay

● Low growth velocity

● pathologcal
● If normal growth velocity : 5 cm per year
● Next step to calculate target height (mid parental
height)
What is the target height (mid parental
height)?
● Example
● A girl with 85 cm
● Father is 165 cm
● Mother is 155 cm
● Calculate the range of mid parental height
● 155+165 = 320 -13= 307
● 307/2= 153.5
● Mid parentral height
● Range: 145.5-161.5 cm
Normal growth velocity 5 cm/year
Height within target height
Diagnosis: Familial short stature
19 years old and this his growth curve
Normal growth velocity
Catch up with target height at puberty
Diagnosis: Constitutional growth delay
What does the growth curve shows
What are the causes
Name the investigations?
low growth velocity (patholigcal)
Height affected more than weight
Causes
● In pathological short stature if height affected more
than weight
● 1-Endocrine
● Hypothyroidism
● Growth hormone def
● Hypopitutarism
● Cushing syndrome
● 2-Turner syndrome
● 3-Systemic disease or malnutrition
● Investigations
● Bone age (non dominant hand)
● Thyroid function test
● Growth hormone stimulation test
● FSH , LH
● MRI pituitary
● Karyotyping
● In Pathological short statue
● If weight is affected more than height
● Systemic disease or malnutrtion
● Endocrine causes
● Turner syndrome
● Bone age
● Assess nutrtion statues:
● Caloric intake
● CBC
● Albumin
● Serm tranferin
● Bone profile Vitamin D
● LFT
● Celiac
● Glusoce
● Renal function
Failure to thrive
● Causes
● Most common : Non-organic (psychosocial) Most
● Others
● Celiac disease
● Chronic renal disease
● Malbasoprtion
● Congenital heart disease
● Cystic fibrosis
● Sickle cell disease