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A 22-year-old nursing school graduate is evaluated during preemployment physical examination for a job at a children's hospital. She has systemic lupus erythematosus, which is well controlled with prednisone, 10 mg daily. She has no recollection of chickenpox as a child; results of a varicella titer are negative.

Which of the following is the most appropriate recommendation?

A. No vaccination

B. Single vaccination (shortened series), clear for work

C. Single vaccination (shortened series), delay work for 4 weeks

D. Two-dose vaccination series over 6 weeks, delay work for 4 weeks

D. This patient would require 2-dose vaccination with varicella. The patient is employed at a health care facility, and therefore required to have either serologic evidence of immunity to or a 2-dose vaccination series with varicella. Nonvaccination is not an option in this case given the profession of the patient and the potential risk to her patients if she were to have primary varicella infection. B and C are incorrect because varicella immunization is a 2-dose series.

An 18-year-old woman presents with a 3-month history of a painful, thick, endophytic papule on the sole of her right foot. She has never had the lesion treated and wants to know if it is infectious. Which one of the following HPV subtypes can be responsible for her disease?

A. HPV 16

B. HPV 2

C. HPV 1

D. HPV 1, 2, 4

E. All of the above

D. The patient is presenting with a classic example of plantar wart (myrmecia). The HPV subtypes responsible for plantar warts are HPV 1, 2, 4, and 63. The HPV subtype 16 is associated with ungula squamous cell carcinoma and cervical/anogenital cancers.

A healthy 25-year-old sexually active man presents to your office. He is concerned about the risk of genital warts and inquires about potential options available for prevention. What is an FDA-approved preventative therapy available for this patient?

A. No preventative therapy available

B. HPV quadrivalent vaccine

C. HPV vaccine against subtypes 16 and 18

D. HPV vaccine against subtypes 6 and 11

B. The patient is interested in prevention of genital warts. Currently there are 2 FDA-approved HPV vaccines, however only one, Gardasil, is indicated for prevention of cervical ...

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