AMC MCQ Immunisation Questions: 10 Free Practice MCQs

Ten AMC MCQ-style immunisation questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 24 immunisation questions and many more across every topic.

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1. 1 / 10

   A 27-year-old woman at 14 weeks gestation has never had an influenza vaccine and is worried about receiving one while pregnant. She has no chronic medical conditions and is otherwise well.

   What is the most appropriate advice?

   • A. Influenza vaccination is strongly recommended at any trimester in each pregnancy
   • B. Vaccination should be deferred until the postpartum period
   • C. Vaccination is recommended only if she has a chronic lung condition
   • D. The live attenuated influenza vaccine is preferred in pregnancy
   Show answer

   Answer: A. Influenza vaccination is strongly recommended at any trimester in each pregnancy

   Why: Vaccination of pregnant women is strongly recommended to protect them against respiratory illness including influenza. RANZCOG advises influenza vaccination for all pregnant women at any trimester in each pregnancy, especially if the pregnancy falls during the influenza season, and it is also safe to receive while breastfeeding. Deferring to the postpartum period would leave her unprotected, and the recommendation is not restricted to women with chronic respiratory disease. Inactivated vaccine is used in pregnancy rather than a live attenuated product.

   • B. Waiting until after birth leaves both mother and infant unprotected through the period of highest risk for severe influenza.
   • C. The recommendation applies to all pregnant women and is not limited to those with pre-existing respiratory disease.
   • D. A live attenuated influenza vaccine is not the preferred product in pregnancy, where the inactivated vaccine is used.

   Sources: RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023

2. 2 / 10

   A 31-year-old woman is 9 weeks pregnant. She has just realised that she received an MMR vaccine two weeks before her positive pregnancy test. She is distressed and asks whether the pregnancy should be terminated.

   What is the most appropriate advice?

   • A. Termination should be offered because live vaccines are teratogenic in the first trimester
   • B. She should receive varicella zoster immunoglobulin immediately
   • C. Serial amniocentesis is required to exclude fetal rubella infection before any decision is made about the pregnancy
   • D. Reassure her that inadvertent live vaccination has not been shown to cause fetal harm and is not a reason for termination
   Show answer

   Answer: D. Reassure her that inadvertent live vaccination has not been shown to cause fetal harm and is not a reason for termination

   Why: Pregnant women who are inadvertently administered a live attenuated vaccine, including MMR or varicella, at any time in pregnancy should be reassured that there has been no evidence of adverse fetal effects or other adverse events from vaccination during pregnancy, and inadvertent vaccination is not a reason for abortion. Health professionals are still required to report adverse events according to jurisdictional guidelines. Immunoglobulin, amniocentesis and termination have no role in this situation.

   • A. There is no evidence of adverse fetal effects from inadvertent live vaccination, so termination is not indicated and should not be presented as necessary.
   • B. Immunoglobulin is given after varicella exposure and plays no part in the management of inadvertent MMR vaccination.
   • C. Amniocentesis does not test for vaccine related harm and would add procedural risk without answering the question she raises.

   Sources: RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023

3. 3 / 10

   A 26-year-old woman attends for pre-pregnancy advice. Her rubella and varicella serology show that she is non-immune to both, and she is not currently pregnant. She hopes to conceive soon.

   What advice should she be given about vaccination?

   • A. Receive the MMR and varicella vaccines during the first trimester if she conceives
   • B. Receive the MMR vaccine and try to conceive in the same week
   • C. Receive the MMR and varicella vaccines and avoid pregnancy for 28 days afterwards
   • D. Avoid MMR and varicella vaccination permanently because she plans to conceive
   Show answer

   Answer: C. Receive the MMR and varicella vaccines and avoid pregnancy for 28 days afterwards

   Why: Immunisation providers should make every effort to identify and immunise non-immune women of childbearing age against rubella and varicella. Both are given as live vaccines and pregnancy should be avoided for 28 days after vaccination. They cannot be given during pregnancy, so the pre-pregnancy consultation is the correct opportunity. Vaccination should not be withheld simply because she plans to conceive, and she can receive the vaccines now and then conceive after the 28 day interval.

   • A. Both are live vaccines and are contraindicated in pregnancy, so they cannot be given once she conceives.
   • B. Pregnancy should be avoided for 28 days after MMR vaccination because of the theoretical risk associated with a live vaccine.
   • D. Vaccination is encouraged before conception rather than avoided, since immunity protects both the woman and any future pregnancy.

   Sources: RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023

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5. 4 / 10

   A 29-year-old woman is 30 weeks pregnant in early autumn. She asks whether she can be vaccinated so that her baby is protected against respiratory syncytial virus during the first months of life.

   What is the most appropriate advice?

   • A. Maternal RSV vaccination is recommended in the first trimester only
   • B. A single dose of maternal RSV vaccine is recommended at 28 to 36 weeks gestation
   • C. RSV vaccination is not recommended at any stage of pregnancy
   • D. The infant should receive a monoclonal antibody before birth
   Show answer

   Answer: B. A single dose of maternal RSV vaccine is recommended at 28 to 36 weeks gestation

   Why: A single dose of maternal respiratory syncytial virus vaccine is recommended for pregnant women at 28 to 36 weeks gestation to protect the infant. Passive immunisation with a long acting monoclonal antibody is an alternative for infants, and it is offered after birth to infants whose mothers did not receive the vaccine during pregnancy, to those born within two weeks of maternal vaccination, and to higher risk infants after assessment. Timing the maternal dose in the third trimester maximises antibody transfer before birth.

   • A. The maternal dose is timed for the third trimester so that protective antibody is transferred close to birth, not in early pregnancy.
   • C. Maternal vaccination is actively recommended during pregnancy, while passive monoclonal antibody is reserved for selected infants.
   • D. Monoclonal antibody is given to the infant after birth and not before delivery, with maternal vaccination the antenatal option.

   Sources: RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023 (interim update October 2024)

6. 5 / 10

   A 22-year-old agricultural student is about to start a placement on a sheep dairy farm. She presents for Q fever vaccination.

   What screening must be performed before administering the Q fever vaccine?

   • A. No screening is required if she has no history of clinical illness.
   • B. A skin test only, as serology is not sensitive enough.
   • C. Both Q fever skin test and Q fever serology (blood test).
   • D. A blood test only, as the skin test is no longer recommended.
   Show answer

   Answer: C. Both Q fever skin test and Q fever serology (blood test).

   Why: Administering Q fever vaccine to someone with pre-existing immunity can cause severe local and systemic hypersensitivity reactions. Screening with both serology and a skin test is mandatory prior to vaccination.

   • A. Asymptomatic exposure is common and screening is always mandatory.
   • B. Both tests are required because either indicates prior sensitization.
   • D. Both skin test and serology are mandatory screening steps.

   Sources: Australian Immunisation Handbook

7. 6 / 10

   A 30-year-old woman at 24 weeks gestation in her second pregnancy asks about vaccination against pertussis. Her last tetanus containing booster was given six years ago and her first child is fully immunised.

   What is the most appropriate advice regarding dTpa vaccination?

   • A. Vaccination is only needed after delivery if the baby is not immunised on time
   • B. A single dose is recommended in each pregnancy, ideally between 20 and 32 weeks
   • C. Vaccination should be given in the first trimester of every pregnancy
   • D. Vaccination is contraindicated in pregnancy and should be delayed until breastfeeding
   Show answer

   Answer: B. A single dose is recommended in each pregnancy, ideally between 20 and 32 weeks

   Why: Data suggest that pertussis vaccination during pregnancy is more effective in reducing the risk of pertussis in young infants than vaccinating the mother postpartum. RANZCOG recommends dTpa vaccine as a single dose during the third trimester of each pregnancy, with the optimal time between 20 and 32 weeks, so that maternal antibody is transferred to the fetus before birth. Vaccination is therefore due now, is not contraindicated, and is recommended in every pregnancy regardless of how recently a booster was given.

   • A. Vaccination during pregnancy is more effective at protecting young infants than vaccinating the mother after birth, so it should not be deferred to the postpartum period.
   • C. The recommended timing is the third trimester rather than the first, so that antibody transfer to the fetus is maximised near term.
   • D. dTpa is not contraindicated in pregnancy; it is actively recommended, and it may also be given while breastfeeding.

   Sources: RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023

8. 7 / 10

   A 12-year-old student is in year 7 and is about to receive vaccines through the school-based immunisation program. His parents ask which vaccines are offered at this age.

   Which vaccines are provided at 12 to 13 years of age?

   • A. Meningococcal ACWY and meningococcal B only
   • B. Diphtheria-tetanus-pertussis and human papillomavirus
   • C. Hepatitis B and varicella catch-up doses
   • D. Influenza and pneumococcal
   Show answer

   Answer: B. Diphtheria-tetanus-pertussis and human papillomavirus

   Why: The National Immunisation Program offers a diphtheria-tetanus-pertussis booster and the human papillomavirus vaccine at 12 to 13 years, usually delivered in year 7, with meningococcal ACWY offered at 14 to 16 years. Hepatitis B, varicella, influenza and pneumococcal vaccines are not part of the adolescent school program.

   • A. Meningococcal ACWY is offered later in the school program, at 14 to 16 years, rather than at 12 to 13 years.
   • C. These are childhood vaccines and are not part of the year 7 program.
   • D. Influenza is seasonal and pneumococcal is a childhood vaccine, so neither is part of the adolescent school program.

   Sources: Australian Government Department of Health, Disability and Ageing: Immunisation for adolescents

9. 8 / 10

   A 19-year-old university student has no record of adolescent vaccines. He missed the human papillomavirus and meningococcal ACWY doses offered at school and asks whether they are still free.

   What is the correct advice under the National Immunisation Program?

   • A. Missed adolescent vaccines are free only until age 16
   • B. Only the human papillomavirus vaccine can be caught up
   • C. Catch-up is free up to age 20, with the human papillomavirus vaccine free up to and including age 25
   • D. No catch-up is funded once the school program has been missed, so he would need to pay for both vaccines privately
   Show answer

   Answer: C. Catch-up is free up to age 20, with the human papillomavirus vaccine free up to and including age 25

   Why: Eligible people can receive free National Immunisation Program catch-up vaccines up until age 20, with the human papillomavirus vaccine funded up to and including age 25, so his missed school doses remain free. Catch-up is not limited to age 16 and is not restricted to a single vaccine, and it remains available even though the school program has been missed.

   • A. Catch-up is funded well beyond 16 years, so this advice would wrongly exclude him from funded doses.
   • B. Catch-up applies to missed routine and adolescent vaccines generally, not just the human papillomavirus vaccine.
   • D. The program funds catch-up for people who miss school vaccines, so this advice is incorrect.

   Sources: Australian Government Department of Health, Disability and Ageing: National Immunisation Program Schedule

10. 9 / 10

    A 34-year-old woman is Rh(D) negative and her record suggests she may have formed her own anti-D, but the documentation is unclear and the treating clinician cannot be reached.

    What is the most appropriate action?

    • A. Give anti-D only if the antibody titre is above 1 in 32 on a repeat sample sent today
    • B. Withhold anti-D and repeat the antibody screen in two weeks
    • C. Give a reduced dose of 250 IU instead of the full dose
    • D. Administer Rh(D) immunoglobulin because continuing doubt should be resolved in favour of giving it
    Show answer

    Answer: D. Administer Rh(D) immunoglobulin because continuing doubt should be resolved in favour of giving it

    Why: Rh(D) immunoglobulin should not be given to women with preformed anti-D antibodies, except where the anti-D detected is due to antenatal administration of the immunoglobulin itself. Where it is unclear whether the anti-D in the mother's blood is passive or preformed, the patient record should be checked and the treating clinician consulted to confirm whether immunoglobulin was given during the pregnancy. If there is continuing doubt, Rh(D) immunoglobulin should be administered. No titre threshold applies, deferring the dose risks sensitisation, and reducing the dose would give inadequate cover at this gestation.

    • A. No titre threshold is used to decide in this situation, and waiting for a particular value would leave the woman unprotected.
    • B. Deferring the dose for a fortnight risks sensitisation during the interval, when the correct action is to treat now.
    • C. A reduced first trimester dose would not provide adequate cover for a potentially sensitising event at this gestation.

    Sources: RANZCOG Guidelines for the use of Rh(D) Immunoglobulin (Anti-D) in obstetrics (C-Obs 6)

11. 10 / 10

    A 32-year-old woman at 8 weeks gestation in her third pregnancy had a rubella antibody titre documented as immune during a pregnancy three years earlier. She asks whether this test needs to be repeated in the current pregnancy.

    What is the most appropriate advice about rubella antibody testing in this pregnancy?

    • A. Measure the rubella antibody titre again in this pregnancy
    • B. Rely on the documented immunity from three years ago
    • C. Defer antibody testing until 36 weeks gestation
    • D. Give the MMR vaccine now to boost her immunity
    Show answer

    Answer: A. Measure the rubella antibody titre again in this pregnancy

    Why: RANZCOG recommends that all women have their rubella antibody titre measured for each pregnancy, because antibody levels may decline over time, particularly following immunisation compared with natural infection. Documented immunity from a previous pregnancy, even a recent one, does not remove the need to test again. Testing is arranged at booking rather than late in pregnancy, and MMR cannot be given antenatally because it is a live vaccine, so non-immune women are vaccinated in the postpartum period instead.

    • B. Earlier antenatal results are not accepted as sufficient to exclude repeat testing, because protective antibody levels may have declined since that pregnancy.
    • C. Testing in late pregnancy would leave no time to organise vaccination before delivery, whereas the titre belongs with the booking investigations.
    • D. MMR is a live vaccine and is contraindicated during pregnancy, so any need for vaccination must be met after the birth.

    Sources: RANZCOG Routine antenatal assessment in the absence of pregnancy complications (C-Obs 3b), March 2022; RANZCOG Pre-pregnancy and pregnancy-related vaccinations (C-Obs 44), March 2023

Exam-style questions written by MedHub for practice. They are not official exam questions.