Set 1: For each patient, select the most appropriate vaccination decision.
A. Defer all vaccines for 12 months
B. Do not administer the vaccine today; seek specialist advice because of possible true contraindication
C. Give half the vaccine dose
D. Give antibiotics before vaccination
E. Vaccinate today if the patient is otherwise well, with usual advice and safety-netting
F. Give live vaccine instead because it is more effective
G. Avoid all future vaccines permanently
H. Give the vaccine intradermally instead of intramuscularly
1. A 4-year-old child attends for routine immunisations. He has mild coryza and a temperature of 37.4°C but is eating, drinking and playing normally. His parent asks whether vaccination should be delayed.
Which option is most appropriate?
2. A 17-year-old had immediate wheeze, facial swelling and hypotension within minutes of a previous dose of the same vaccine. He now attends for the next scheduled dose.
Which option is most appropriate?
Set 2: For each patient, select the most appropriate vaccine-related advice.
A. Give MMR during pregnancy to prevent congenital rubella
B. Offer pregnancy-appropriate vaccines and avoid live vaccines unless specialist advice supports use
C. Avoid all vaccines during pregnancy
D. Give postpartum MMR if non-immune and not pregnant, with appropriate contraception advice
E. Give yellow fever vaccine routinely to all pregnant women
F. Give oral typhoid vaccine as first-line in pregnancy
G. Reassure that whooping cough vaccination is only needed after delivery
H. Delay all vaccine discussions until the baby is 1 year old
3. A woman who is 28 weeks pregnant asks whether vaccines are relevant. She has not yet had her whooping cough vaccine and asks whether live vaccines such as MMR are suitable now.
Which option is most appropriate?
4. A woman is found to be rubella non-immune during pregnancy. She has now delivered, is not pregnant and wants to know how to reduce risk in a future pregnancy.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate option.
A. Use a suitable non-live vaccine where indicated and avoid live vaccines during significant immunosuppression unless specialist advice supports use
B. Give live intranasal influenza vaccine routinely
C. Stop all immunosuppressants permanently before any vaccine
D. Avoid all non-live vaccines because they cause infection
E. Give live shingles vaccine to all immunosuppressed patients
F. Delay all vaccines until age 80
G. Consider non-live shingles vaccination if eligible and arrange according to programme guidance
H. Reassure that immunosuppression does not affect vaccine choice
5. A 42-year-old woman takes adalimumab and methotrexate for inflammatory bowel disease. She asks whether she can receive the live intranasal influenza vaccine because her child is having it at school.
Which option is most appropriate?
6. A 45-year-old man is severely immunosuppressed after treatment for lymphoma. He asks whether there is any shingles vaccine option because he has heard live shingles vaccines are unsuitable.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate pharmacist action.
A. Use the vaccines if they still look clear
B. Put breached vaccines back into stock and continue using them
C. Recognise likely vasovagal episode, lay the patient flat, monitor and distinguish from anaphylaxis
D. Treat as anaphylaxis with immediate adrenaline and emergency support
E. Warm vaccines above room temperature before use
F. Quarantine affected vaccines, label “do not use”, document the incident and seek cold chain advice
G. Ignore missing fridge temperature records if no patient complains
H. Give oral antihistamine only for airway compromise
7. A vaccine fridge temperature log shows the fridge reached 13°C overnight. Several vaccines remain in the fridge, and it is unclear how long they were outside the recommended range.
Which option is most appropriate?
8. A 19-year-old becomes pale, sweaty and light-headed within 1 minute of vaccination. His pulse is slow, he improves rapidly when lying flat, and he has no wheeze, swelling or rash.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate management option.
A. Explain benefits and risks clearly, address concerns respectfully and support informed consent
B. Give no vaccines because asplenia is not a risk factor
C. Arrange appropriate vaccination and infection-prevention advice for asplenia according to schedule/local guidance
D. Force vaccination because refusal is illegal
E. Give antibiotics instead of all vaccines
F. Reassure that vaccine-preventable infections are always mild
G. Avoid documenting vaccine discussions
H. Give all childhood vaccines as one adult dose without checking history
9. A 36-year-old man has had an emergency splenectomy after trauma. He asks why he needs several vaccines and whether he will need any other infection-prevention advice.
Which option is most appropriate?
10. A parent is worried that vaccines “overload the immune system” and asks whether they can delay all childhood vaccines until school age. The child has no contraindications.
Which option is most appropriate?
Answers and Rationale
1. E
Mild illness without significant fever or systemic upset is not usually a reason to delay vaccination. Delaying routine immunisation unnecessarily can leave the child unprotected.
2. B
Immediate wheeze, facial swelling and hypotension after a previous dose suggests anaphylaxis to the vaccine or a component. The next dose should not be given without specialist advice.
3. B
Pregnancy is a key opportunity to offer appropriate vaccines such as whooping cough, flu and RSV depending on timing and eligibility. Live vaccines such as MMR are generally avoided in pregnancy unless specialist advice indicates otherwise.
4. D
MMR is contraindicated during pregnancy but can be given postpartum if the woman is not pregnant. Appropriate contraception advice should be given because pregnancy should be avoided for a period after live MMR vaccination.
5. A
Significant immunosuppression affects vaccine choice. Live vaccines are generally avoided unless specialist advice supports use, while suitable non-live vaccines may still be recommended.
6. G
The non-live shingles vaccine may be suitable for eligible immunosuppressed adults. Eligibility, timing and dosing should be checked against current programme guidance and specialist advice if needed.
7. F
A cold chain breach means vaccines should be quarantined and clearly labelled not for use while advice is sought. They should not be returned to stock based on appearance alone.
8. C
Pallor, sweating, bradycardia and rapid recovery when lying flat suggest a vasovagal episode. This must be distinguished from anaphylaxis, which is more likely to involve airway, breathing or circulation compromise with allergic features.
9. C
Asplenia increases risk from encapsulated organisms. Vaccination, booster planning and infection-prevention advice should be arranged according to current guidance.
10. A
Concerns should be addressed respectfully with clear explanation of benefits and risks. The aim is informed consent and timely protection, not coercion or dismissal.
Here are 10 extended matching questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.