Tetanus Immunity Posttest PDF

Tetanus Immunity Posttest Select the best answer for each question. Please mark your answers on this exam to facilitate discussion and later review. If your instructor has provided a separate answer form, be sure you have identified yourself on the form, then begin your answers with question 1. Mark...

Tetanus Immunity Posttest Select the best answer for each question. Please mark your answers on this exam to facilitate discussion and later review. If your instructor has provided a separate answer form, be sure you have identified yourself on the form, then begin your answers with question 1. Mark your answers both on the form and on this exam. Only one answer is correct. 1. A 23-year-old medical student who had four injections of diphtheria, pertussis, and tetanus (DPT) in her first year of life and a booster at age 5, but no subsequent tetanus immunization, is bitten by a mouse while doing an experiment. She should be given (A) tetanus toxoid, which will passively immunize her. (B) tetanus antitoxin (equine), which will passively immunize her. (C) tetanus immune globulin (human), which will passively immunize her. (D) tetanus toxoid, which will actively immunize her. (E) tetanus immune globulin (human), which will stimulate an anamnestic response. 2. A 10-year-old girl who received a deep laceration when she was water skiing was just brought into your office. Her parents state that she has had no previous immunization against tetanus. As protection against the possibility of tetanus now and in the future, the preferred method of treatment would be (A) a mixture of tetanus toxoid and tetanus immune globulin (human) as one injection. (B) a tetanus toxoid injection this visit, with an injection of tetanus immune globulin (human) approximately three weeks later. (C) separate injections of tetanus toxoid and tetanus immune globulin (human) in different sites on this one visit. (D) a tetanus immune globulin (human) injection this visit, with an injection of tetanus toxoid about three weeks later. (E) a tetanus immune globulin (human) injection this visit, with an injection of tetanus toxoid about five weeks later. 3. You know that your 3-year-old patient received the standard DPT immunization series starting at 3 months of age. You discovered recently that he has no detectable antibody to diphtheria, pertussis, or tetanus and hence is deficient in his humoral immunity. You are faced with treating him for a deep puncture wound in his foot, which he obtained while playing near his grand father's barn. The best treatment to prevent tetanus would be (A) active immunization with tetanus toxoid. (B) active immunization with tetanus toxin. (C) passive immunization with tetanus antitoxin (equine). (D) passive immunization with tetanus immune globulin (human). (E) none of the above. Under the circumstances, it is best to avoid any type of injection. Tetanus 051900 1 Tetanus Immunity 4. Administration of tetanus immune globulin (human) has been decided upon for the immediate protection of a patient with a two-inch deep cut in his thigh. The patient is a normal 6-year-old. You must consider (A) that the antibody half-life is such that passive immunization should be repeated every two to three weeks. (B) that the antibody half-life is such that active immunization with tetanus toxoid should also be done, since prolonged protection is desired. (C) the possibility that serum sickness will occur. (D) the possibility that hypersensitivity (anaphylaxis) will occur. (E) that the blood types must be properly matched. 5. Serum sickness can be a serious problem after which of the following? (A) Injection of tetanus toxoid (B) Injection of tetanus antitoxin (equine) (C) Injection of tetanus immune globulin (human) (D) Injection of tetanus toxin (E) None of the above 6. Active immunization after exposure to an infectious disease should be done to prevent that disease if (A) the incubation period of the disease exceeds the time required to produce immunity. (B) the patient has been previously immunized and hence will have an anamnestic immune response. (C) the immunity is antibody-mediated. (D) the patient is very sick. (E) the immunity is cell-mediated. 7. Reckless Richard, your accident-prone, 10-year-old patient, has just come in with a deep puncture wound on his foot. Your records show that he had a standard DPT series as a baby and a booster at age 5 and again six months ago after another bad wound. The proper treatment is (A) tetanus toxoid. (B) tetanus antitoxin (equine). (C) tetanus immune globulin (human). (D) tetanus toxoid and tetanus immune globulin (human) at two different sites. (E) no tetanus immunization. 8. Diphtheria toxoid, like tetanus toxoid, is an effective inducer of active immunity because it is (A) immunogenic but not antigenic. (B) antigenic but not immunogenic. (C) both immunogenic and antigenic. (D) chemically identical to diphtheria toxin. (E) an active toxin. Tetanus 051900 Posttest - 2 Tetanus Immunity 9. Immunity induced by tetanus toxoid injection is (A) specific and cell-mediated. (B) innate and nonspecific. (C) cell-mediated and innate. (D) antibody-mediated and active. (E) nonspecific and passive. 10. Protection of a patient by administration of passive antibody has one primary advantage over active immunization, which is that it (A) is cheaper. (B) hurts less. (C) gives higher antibody titers. (D) provides antibody more rapidly. (E) provides antibody for a longer time. Define the following terms in the space provided. (If your instructor has provided a separate answer form, do not use it to answer questions 11 through 15; answer those questions below only.) 11. Antibody 12. Antigen 13. Immunity 14. In a patient with a fresh wound that might be infected with Clostridium tetani, under what circumstances would you administer passive antibody? 15. Design an experiment to determine if cell-mediated immunity is important in protection against a bacterial disease of mice. When you have finished the posttest, discuss your answers with your colleagues and then compare them with the correct answers. (See last pages in the workbook, or follow your instructor's directions.) Posttest answers are on the following pages. DO NOT LOOK AT THEM OR REMOVE THEM UNTIL YOU HAVE COMPLETED THE POSTTEST. Tetanus 051900 Posttest - 3 Tetanus Immunity Posttest Answers Discuss answers with each other to be sure none of you have any misconceptions! 1. D is correct. The anamnestic response will provide antibody before the Clostridium tetani can produce enough toxin to harm the patient. Stated another way: although the patient does not have enough antibody present in her serum to protect her from tetanus, she does have memory lymphocytes that are "ready and waiting to be turned on." C is wrong because tetanus immune globulin (human) is both expensive and unnecessary in previously immunized patients. Passive immunization will not provide protection for more than several months. Tetanus toxoid will protect her for five to ten years. 2. C is the treatment approved by the Public Health Service. The patient may not return and would remain susceptible to tetanus in the future if she is given only passive antibody. You should also ask her to return for two tetanus toxoid booster injections. 3. D is correct. The child cannot produce antibody; therefore, there are no memory cells to count on! This is a rare patient. The problem-solving session on Immunodeficiency Disease covers this. 4. B is correct. 5. B is correct. 6. A is always correct. B is correct for some diseases but not all. It is always necessary for the onset of immune response to "beat" the disease. This does not occur in infectious diseases with short incubation periods (e.g. influenza or botulism) nor in other situations such as snake bite, even with active booster immunization. 7. E is correct. The patient has adequate immunity due to prior immunization. The Public Health Service suggests a booster when the last booster was given more than five years previously. 8. C is correct. 9. D is correct. The immunity is specific for tetanus. It is antibody-mediated as proven by the fact that passive administration of antibody will protect. Passive transfer (adoptive immunity) of sensitized T-cells will not protect the recipient. Since an antigen has stimulated the body to produce antibody, it is active immunity. 10. D is correct. Tetanus 051900 1 Tetanus Immunity 11. Antibody Key Points: A protein produced by the body or B-lymphocytes in response to a stimulation by an antigen and which will combine with that antigen. 12. Antigen Key Points: A macromolecular substance which, when introduced into an animal will stimulate the synthesis of antibody and which will combine with that antibody. 13. Immunity Key Points: Insusceptibility to a pathogenic microorganism or its toxin(s). 14. A patient should be given passive antibody when no prior history of active tetanus immunization can be provided. 15. Take T-cells from immune mice, inject them into normal mice of the same strain, and then challenge the mice with the bacteria. If the mice get sick, and/or die, cell-mediated immunity (CMI) is NOT important. If they remain well, CMI is protective. This process of transferring immunity is called adoptive immunity. It is not really passive because the transferred lymphocytes are actively synthesizing lymphokines. The lymphocytes have been “adopted” by the new host. Most people answered by suggesting a challenge of neonatally thymectomized or nude mice with the injected bacteria, then looking for death as an endpoint (in comparison with control mice) to determine the role of CMI due to a lack of T-cells. T-cells participate in the initiation of humoral immunity via cytokine production and its interaction with B-cells. So, removing T- cells would impact the ability of the mice to launch a complete immune response, but it would be hard to delineate whether CMI or humoral immunity was most important. Also, wouldn’t both the thymectomized and control groups of mice be expected to succumb to the infection if there was no previous exposure to the bacteria? (The answer here would be to use a sublethal dose and look for clinical signs of infection instead of counting the dead mice). Tetanus 051900 Post Ans - 2