Block 9 Vaccines Abx Infxn Cntrl And Ethics MCQ's

1. A former patient calls you on the phone and expresses their interest to pursue a personal and intimate relationship with you. They further express a very strong attraction to your caring, gentle, and highly competent manner of relating to patients. The most ethical manner of dealing with this patient is to:

Feel free to reciprocate if interested

Feel free to reciprocate if you have not seen this patient for at least one year

Consult with a colleague before making a decision.

Respectfully decline the offer while allowing the patient to maintain integrity.

It depends on how hot she is

The most ethical manner of dealing with this situation is to respectfully decline the patient's offer while still maintaining their integrity. Engaging in a personal and intimate relationship with a former patient is considered unethical due to the power dynamics and potential for exploitation. It is important to prioritize the patient's well-being and maintain professional boundaries. Consulting with a colleague before making a decision can also be helpful in navigating this situation.

Explanation

The most ethical manner of dealing with this situation is to respectfully decline the patient's offer while still maintaining their integrity. Engaging in a personal and intimate relationship with a former patient is considered unethical due to the power dynamics and potential for exploitation. It is important to prioritize the patient's well-being and maintain professional boundaries. Consulting with a colleague before making a decision can also be helpful in navigating this situation.

2. You are socializing with some friends at a nightclub when a very attractive patient, whom you examined two days previously, approaches you and whispers in your ear that they cannot stop thinking about you and wishes to get to know you better. They even tell you that they are so interested in you that they intend to no longer be your patient so you can be free to pursue something with them. You feel quite flattered, excited, and interested. The most ethical course of action would be to:

Wait two years and then make a decision

Consult with your attorney

Respectfully decline the offer while allowing patient to maintain integrity

Feel free to pursue a relationship as they are no longer your patient.

If she is really hot, it would be ok, just this one time

The most ethical course of action would be to respectfully decline the offer while allowing the patient to maintain their integrity. Engaging in a romantic or personal relationship with a former patient can be seen as a breach of professional boundaries and can compromise the trust and integrity of the doctor-patient relationship. It is important to prioritize the well-being and best interests of the patient and maintain professionalism in all interactions.

Explanation

The most ethical course of action would be to respectfully decline the offer while allowing the patient to maintain their integrity. Engaging in a romantic or personal relationship with a former patient can be seen as a breach of professional boundaries and can compromise the trust and integrity of the doctor-patient relationship. It is important to prioritize the well-being and best interests of the patient and maintain professionalism in all interactions.

3. A new virus, Grouch Papilloma Virus, has been isolated from a Grouch population living in a small community in New York City. While primary infection is largely asymptomatic, the virus is known to establish latency and causes sduamous cell carcinoma in a high proportion of latently infected patients. Development of a vaccine is underway. Why would an inactivated vaccine be a better choice than a live vaccine for this organism?

Inactivated vaccines are strong stimulators of cell-mediated immunity

Live organisms in live vaccines have no chance of establishing latency

Inactivated vaccines are always the best choice for viruses.

With an inactivated vaccine, there is no need for booster shots.

With an inactivated vaccine, there is no risk for the organism to drive oncogenesis.

Inactivated Vaccines
Inactivated vaccines, as the name implies, can produce a protective immune response without the risk of infection by the agent. They are used for agents that cannot be attenuated, that may cause recurrent infection, or that have ONOGENIC POTENTIAL.

Explanation

Inactivated Vaccines
Inactivated vaccines, as the name implies, can produce a protective immune response without the risk of infection by the agent. They are used for agents that cannot be attenuated, that may cause recurrent infection, or that have ONOGENIC POTENTIAL.

4. Which of the following vaccines contain toxoids?

Trivalent influenza A and influenza B

Measles, mumps,rubella

Haemophilus influenzae type b

Pneumococcal polysaccharide vaccine

Diphtheria, tetanus, pertussis

Diphtheria, tetanus, pertussis (DTaP) vaccine contains toxoids. Toxoids are inactivated toxins that are used in vaccines to stimulate an immune response without causing the disease. In the case of DTaP vaccine, the toxoids of diphtheria and tetanus are included to provide immunity against these diseases. The vaccine helps the body develop antibodies to fight against the toxins produced by the bacteria that cause diphtheria and tetanus.

Explanation

Diphtheria, tetanus, pertussis (DTaP) vaccine contains toxoids. Toxoids are inactivated toxins that are used in vaccines to stimulate an immune response without causing the disease. In the case of DTaP vaccine, the toxoids of diphtheria and tetanus are included to provide immunity against these diseases. The vaccine helps the body develop antibodies to fight against the toxins produced by the bacteria that cause diphtheria and tetanus.

5. This 40 year old patient is complaining of chest pain which begins on the left side of the chest. On occasion the pain radiates up into the jaw area and down his left arm. You explain that this is the pain of angina pectoris which suggests narrowing of the blood vessels of the heart. You suggest that he takes cardiac catherization to establish the diagnosis. He adamantly refuses, "I am too young for that." Your best ethical course of action is?

Call his wife and explain the situation to her.

Bow to the patient's decision respectfully and do nothing.

Let the Ethics Committee decide

Approach the court with an order forcing him for his and his family's welfare to cooperate.

As a healthcare professional, it is important to respect the patient's autonomy and right to make decisions about their own healthcare. In this case, the patient has adamantly refused to undergo cardiac catheterization. It would be ethically appropriate to respect his decision and not force him to undergo the procedure against his will. It is important to engage in open and honest communication with the patient, providing information and addressing any concerns or misconceptions he may have.

Explanation

As a healthcare professional, it is important to respect the patient's autonomy and right to make decisions about their own healthcare. In this case, the patient has adamantly refused to undergo cardiac catheterization. It would be ethically appropriate to respect his decision and not force him to undergo the procedure against his will. It is important to engage in open and honest communication with the patient, providing information and addressing any concerns or misconceptions he may have.

6. The vaccine for Anthrax is a killed cell vaccine. Because of the fact that this vaccine is comprised of killed organism, what is a disadvantage of the vaccine?

There is a risk that the vaccine components will secrete the toxins that cause the disease.

The immunity to the organism will wane as soon as the vaccine components are cleared from the body

This vaccine is not appropriate for use in immuncompromised persons

Immunity to this organism is not typically life-long and sustained immunity will require booster shots.

Maintaining viability of the vaccine is a concern

The disadvantage of the killed cell vaccine for Anthrax is that immunity to the organism is not typically life-long and sustained immunity will require booster shots. This means that the vaccine's effectiveness diminishes over time and individuals will need additional doses to maintain their immunity.

Explanation

The disadvantage of the killed cell vaccine for Anthrax is that immunity to the organism is not typically life-long and sustained immunity will require booster shots. This means that the vaccine's effectiveness diminishes over time and individuals will need additional doses to maintain their immunity.

7. Which of the following is true regarding innate immunity?

It provides only weak non-specific responses to pathogens

It operates uniquely at body surfaces

It provides rapid immunity and influences acquired immunity

It involves cells but not secreted proteins

It does not require signaling events

Innate immunity provides rapid immunity and influences acquired immunity. This means that the innate immune system is the first line of defense against pathogens and can quickly respond to infections. It also plays a crucial role in shaping the adaptive immune response, which is the acquired immunity. Innate immunity involves both cells and secreted proteins, such as cytokines and antimicrobial peptides. Signaling events are also required for the activation of innate immune responses.

Explanation

Innate immunity provides rapid immunity and influences acquired immunity. This means that the innate immune system is the first line of defense against pathogens and can quickly respond to infections. It also plays a crucial role in shaping the adaptive immune response, which is the acquired immunity. Innate immunity involves both cells and secreted proteins, such as cytokines and antimicrobial peptides. Signaling events are also required for the activation of innate immune responses.

8. Innate immune responses are like adaptive immunity in that they

Are antigen-specific

Demonstrate immune memory

Involve macrophages and complement

Involve T lymphocytes

Involve B lymphocytes

Innate immune responses involve macrophages and complement. Macrophages are a type of white blood cell that play a crucial role in the innate immune response by engulfing and destroying pathogens. Complement is a group of proteins in the blood that also contribute to the innate immune response by assisting in the destruction of pathogens. This is different from adaptive immunity, which is antigen-specific and involves T and B lymphocytes, as well as immune memory.

Explanation

Innate immune responses involve macrophages and complement. Macrophages are a type of white blood cell that play a crucial role in the innate immune response by engulfing and destroying pathogens. Complement is a group of proteins in the blood that also contribute to the innate immune response by assisting in the destruction of pathogens. This is different from adaptive immunity, which is antigen-specific and involves T and B lymphocytes, as well as immune memory.

9. A 69-year-old man recently diagnosed with a Proteus mirabilis infection started a treatment with a daily 1M injection of gentamicin, an aminoglycoside antibiotic. Which of the following pairs of properties best explains why the drug is usually administered once daily despite the short half-life of gentamicin (about two hours)?

Time-dependent killing and bactericidal effect

Extensive plasma protein binding and bactericidal effect

Dose-dependent renal impairment and bacteriostatic effect

Concentration-dependent killing and long post antibiotic effect

Time-dependent killing and long post antibiotic effect

The reason why gentamicin is usually administered once daily despite its short half-life is because it exhibits concentration-dependent killing and has a long post antibiotic effect. This means that the effectiveness of the drug is dependent on achieving a certain concentration in the body, rather than the duration of exposure. Additionally, gentamicin has a prolonged effect after it is eliminated from the body, allowing for once-daily dosing.

Explanation

The reason why gentamicin is usually administered once daily despite its short half-life is because it exhibits concentration-dependent killing and has a long post antibiotic effect. This means that the effectiveness of the drug is dependent on achieving a certain concentration in the body, rather than the duration of exposure. Additionally, gentamicin has a prolonged effect after it is eliminated from the body, allowing for once-daily dosing.

10. This 90 year old man is brought into the emergency room after a motor vehicle accident. He sustained bilateral fractured ribs and is in respiratory distress because of bilateral pneumothoraces (Pneunornothorax). He is conscious though, but failing fast. He needs to be intubated immediately. His wife calls and tells you that she is on her way with his living will which states that he does not want any heroic measures if he is near death, which in essence he is. What is your best ethical course of action?

Delay intubation until the wife arrives with the living will

Move promptly and intubate your patient in the hope that is life will be saved

Call the other family members and get their opinion

Even though he is in distress, request from him what he now wants to be done,

Defer to the advice of the Ethics Committee

The best ethical course of action in this situation is to request from the patient what he wants to be done, even though he is in distress. This respects the patient's autonomy and allows him to make decisions about his own medical care. It is important to prioritize the patient's wishes and respect his living will, rather than delaying treatment or seeking input from other family members. Defering to the advice of the Ethics Committee may not be necessary in this case, as the patient's wishes can be directly obtained.

Explanation

The best ethical course of action in this situation is to request from the patient what he wants to be done, even though he is in distress. This respects the patient's autonomy and allows him to make decisions about his own medical care. It is important to prioritize the patient's wishes and respect his living will, rather than delaying treatment or seeking input from other family members. Defering to the advice of the Ethics Committee may not be necessary in this case, as the patient's wishes can be directly obtained.

11. Your schizophrenic patient confides in you that he has been hearing voices warning him for weeks now that his parents are trying to kill him. He has now concluded, "I think I will get rid of them before they get rid of me. In fact I will poison them tonight.' How do you manage this situation involving this 16 year old boy?

Immediately admit him to the hospital involuntarily, get an immediate Psychiatry consut and restrain him if necessary.

Discuss the situation with him, finally adding "Both your parents love you, you shou!d not talk this way."

Do not admit him to the hospital but get a Psychiatry consult for two (2) days time

Inform the police but do not inform the parents for both fear of breaching confidentiality and unnecessarily causing them concern.

The patient's statement indicates a clear danger to himself and others, as he is expressing a plan to harm his parents. This is a serious situation that requires immediate intervention to ensure the safety of everyone involved. Admitting him to the hospital involuntarily allows for a comprehensive psychiatric evaluation and the implementation of necessary measures, such as restraint if required, to prevent harm. It is crucial to prioritize the patient's safety and provide appropriate care in this scenario.

Explanation

The patient's statement indicates a clear danger to himself and others, as he is expressing a plan to harm his parents. This is a serious situation that requires immediate intervention to ensure the safety of everyone involved. Admitting him to the hospital involuntarily allows for a comprehensive psychiatric evaluation and the implementation of necessary measures, such as restraint if required, to prevent harm. It is crucial to prioritize the patient's safety and provide appropriate care in this scenario.

12. Due to a psychotic episode your 24 year old female patient, who believes you are conducting medical experiments on her, refuses to undergo critical diagnostic tests for a suspected carcinoma of the lung. The tests you intend to perform are the least intrusive means of determining her medical condition, a condition that could be life-threatening. It has been determined that she is not competent to make decisions regarding her medical care. The most reasonable next step would be to:

Immediately proceed with diagnostic testing,

Attempt to determine what is in the best interest of the patient

Wait and hope that her psychosis abates and competency is restored

Determine from the family what she would have wished had she been competent.

Given that the patient is experiencing a psychotic episode and is not competent to make decisions regarding her medical care, it is important to consider what she would have wanted if she were competent. In this situation, determining the patient's wishes from her family would be the most reasonable next step. This approach respects the patient's autonomy and ensures that her best interests are taken into account, even if she is unable to make decisions for herself at the moment. It allows for a collaborative decision-making process that considers the patient's values and preferences, ultimately aiming to provide the best possible care for her.

Explanation

Given that the patient is experiencing a psychotic episode and is not competent to make decisions regarding her medical care, it is important to consider what she would have wanted if she were competent. In this situation, determining the patient's wishes from her family would be the most reasonable next step. This approach respects the patient's autonomy and ensures that her best interests are taken into account, even if she is unable to make decisions for herself at the moment. It allows for a collaborative decision-making process that considers the patient's values and preferences, ultimately aiming to provide the best possible care for her.

13. What type of immunity is protective against Haemophilus influenzae type b?

Antibodies and complement

Antibodies and phagocytes

T cells and macrophages

IgE and mast cells

There is no protective immune response

Antibodies and complement play a crucial role in protecting against Haemophilus influenzae type b. Antibodies, produced by B cells, specifically target and neutralize the bacteria. Complement, a group of proteins, enhances the immune response by assisting in the destruction of the bacteria. Together, antibodies and complement work synergistically to eliminate the pathogen and provide immunity against Haemophilus influenzae type b.

Explanation

Antibodies and complement play a crucial role in protecting against Haemophilus influenzae type b. Antibodies, produced by B cells, specifically target and neutralize the bacteria. Complement, a group of proteins, enhances the immune response by assisting in the destruction of the bacteria. Together, antibodies and complement work synergistically to eliminate the pathogen and provide immunity against Haemophilus influenzae type b.

14. A new virus, the Semester 3-induced Hysteria virus (SIFIV) has been discovered, This virus is oncogenic, causing brain tumors, and establishes latency in certain individuals. Most individuals who experience natural infection become protected from subsequent infection via the production of antibodies. These antibodies recognize a conformational epitope comprised of the juxtaposition of 2 capsid proteins on the surface of the virus. A vaccine for this virus is underway. Which type of vaccine would be best for this virus?

Live attenuated

Formalin-inactivated viral particles

Subunit vaccine comprised of the 2 recombinantly expressed capsid proteins

A hybrid vaccine consisting of the 2 capsid genes inserted into vaccinia virus

Inactivated Vaccines
Inactivated vaccines, as the name implies, can produce a protective immune response without the risk of infection by the agent. They are used for agents that cannot be attenuated, that may cause recurrent infection, or that have ONOGENIC POTENTIAL.

Explanation

Inactivated Vaccines
Inactivated vaccines, as the name implies, can produce a protective immune response without the risk of infection by the agent. They are used for agents that cannot be attenuated, that may cause recurrent infection, or that have ONOGENIC POTENTIAL.

15. A male patient is hospitalized while in a diabetic coma. Medical records and information provided by the patient's wife indicate a long-standing history of uncontrolled diabetes mellitus. Examination of the patient reveals a gangrenous right leg. if the leg is not immediately amputated, the patient will die. What is the most reasonable and ethical next step for the physician to take?

Amputate the leg immediately without the patient's consent

Do nothing until the patient is competent to provide consent

Exercise the doctrine of substituted judgment.

Exercise the doctrine of best interest

The most reasonable and ethical next step for the physician to take is to exercise the doctrine of substituted judgment. This means that the physician should make decisions on behalf of the patient based on what the patient would have chosen if they were able to make decisions for themselves. In this case, the patient is in a diabetic coma and unable to provide consent, so the physician must act in their best interest by considering their previous medical history and the urgency of the situation.

Explanation

The most reasonable and ethical next step for the physician to take is to exercise the doctrine of substituted judgment. This means that the physician should make decisions on behalf of the patient based on what the patient would have chosen if they were able to make decisions for themselves. In this case, the patient is in a diabetic coma and unable to provide consent, so the physician must act in their best interest by considering their previous medical history and the urgency of the situation.

16. Describe the content of the smallpox vaccine

Live, dsDNA virus derived from variola virus

Live, dsDNA virus derived from vaccinia virus

Killed, dsDNA virus derived from the smallpox virus

Killed, clsRNA virus derived from smallpox virus

Component surface antigen of smallpox virus

Attenuated dsRNA virus derived from cowpox virus

The smallpox vaccine is a live, dsDNA virus derived from the vaccinia virus. This means that the vaccine contains a weakened form of the vaccinia virus, which is similar to the variola virus that causes smallpox. By introducing this weakened virus into the body, the immune system is able to recognize and mount a response against it. This helps to prepare the immune system to fight off a potential smallpox infection in the future.

Explanation

The smallpox vaccine is a live, dsDNA virus derived from the vaccinia virus. This means that the vaccine contains a weakened form of the vaccinia virus, which is similar to the variola virus that causes smallpox. By introducing this weakened virus into the body, the immune system is able to recognize and mount a response against it. This helps to prepare the immune system to fight off a potential smallpox infection in the future.

17. Your 68 year old male patient is hospitalized for a gangrenous right leg secondary to his longstanding history of uncontrolled diabetes mellitus. You inform him that amputation is essential in order to preserve his life. He refuses to consent to such intervention and informs you that he would rather die than be without a leg. What is the most reasonable next step for you to take?

Proceed with the surgery

Report him to his family

Simply leave him alone and respect his wishes

Order a consult for a competency evaluation

The most reasonable next step is to order a consult for a competency evaluation. This is because the patient's refusal of a life-saving intervention may indicate impaired decision-making capacity. A competency evaluation will help determine whether the patient is capable of making informed decisions about his own healthcare. It is important to ensure that the patient's refusal is based on informed consent rather than a result of cognitive impairment or other factors that may affect his decision-making ability.

Explanation

The most reasonable next step is to order a consult for a competency evaluation. This is because the patient's refusal of a life-saving intervention may indicate impaired decision-making capacity. A competency evaluation will help determine whether the patient is capable of making informed decisions about his own healthcare. It is important to ensure that the patient's refusal is based on informed consent rather than a result of cognitive impairment or other factors that may affect his decision-making ability.