1. Healthcare workers could be at high risk in the event of a biologic weapon attack because:

• a. The government is not paying attention.
• b. Early symptoms for many of the likely disease agents are flu-like.
• c. Information is not available about emergency response.
• d. Patients would get preference over healthcare workers for vaccines.

2. Although 500,000 military personnel were vaccinated, few civilian healthcare workers had the voluntary smallpox vaccination by the end of 2003.

• a. True
• b. False

3. Why have some healthcare professionals chosen not to participate in the voluntary smallpox vaccination program?

• a. The CDC has grave concerns about the safety of the vaccine.
• b. Lost time due to vaccine reactions is uncompensated.
• c. Other public health needs suffer when funds are diverted to smallpox vaccination.
• d. Most were vaccinated as children.

4. Variola major, the most common of the two clinical forms of smallpox, has a fatality rate of:

• a. About 10%.
• b. About 30%.
• c. About 75%.
• d. About 90%.

5. Modified smallpox (variola major) is mild and occurs in previously vaccinated people.

• a. True
• b. False

6. In the early 1950s there were 50 million smallpox cases per year, but in 1980 smallpox had been eradicated worldwide.

• a. True
• b. False

7. In the United States today:

• a. The older adults are immune because they were vaccinated more than 30 years ago.
• b. The youngsters are immune because they were born after 1980.
• c. Our nation is as susceptible to smallpox as the ancient civilizations were.
• d. No one needs vaccination because immunity has been passed down from earlier generations.

8. Eradication of smallpox was accomplished via a two-fold strategy:

• a. Quarantine of all cases and megadoses of antibiotics.
• b. Mass vaccination and surveillance to detect and contain outbreaks.
• c. Prophylactic antibiotics combined with isolating gloves and masks.
• d. Dedicated response teams of healthcare workers and vaccination of public service employees.

9. Surveillance programs to detect and contain outbreaks of smallpox proved to be:

• a. The most crucial strategy in early global eradication programs.
• b. Less important than mass vaccinations.
• c. Impossible because people were afraid to report the disease.
• d. Impossible because local populations were afraid to take the vaccine.

10. The world's last case of smallpox occurred in Somalia in 2003.

• a. True
• b. False

11. The World Health Organization maintains two storage laboratories for variola virus in Paris and Beijing.

• a. True
• b. False

12. Epidemiologic studies show that vaccine protection:

• a. Increases just after vaccination but wanes over time.
• b. Is higher the more time has passed since vaccination.
• c. Persists at a protective level without change over time.
• d. Is highest in young children and older adults.

13. One vaccination against smallpox provides lifelong immunity.

• a. True
• b. False

14. Natural transmission of smallpox generally spreads less widely and less rapidly than chickenpox or measles.

• a. True
• b. False

15. Transmission of the variola virus:

• a. Is unusual within a family or household.
• b. Can be through contact with insects or wild animals.
• c. Is more infectious through respiratory secretions than crusted scabs.
• d. Can be prevented by using a condom.

16. Transmission of smallpox is maximal before the appearance of skin lesions.

• a. True
• b. False

17. Transmissibility decreases significantly:

• a. After the first three days.
• b. After the appearance of oropharyngeal lesions.
• c. After the appearance of skin lesions.
• d. After the second week as oral lesions heal.

18. A person infected with smallpox is contagious until the last smallpox scab falls off.

• a. True
• b. False

19. Prodromal means:

• a. Positive signs of improvement.
• b. Early symptoms that mark the onset of disease.
• c. Final stage of an infectious disease.
• d. Successful vaccination.

20. Which statement is true about the stages of smallpox?

• a. The prodromal phase is when the pustular rash appears.
• b. The rash emerges first as small red spots on the tongue and in the mouth.
• c. The rash emerges first as small red spots on the torso.
• d. When the scabs fall off there is minimal scarring on the face.

21. Which early signs and symptoms of smallpox occur 1 to 3 days before the rash?

• a. Fever, headache, body aches, chills, and vomiting
• b. Pharyngitis and severe abdominal pain
• c. Diarrhea and low-grade fever
• d. Severe headache and projectile emesis

22. Which statement is false about the smallpox rash?

• a. Ordinary smallpox has a generalized rash with lesions found more densely on the face and extremities.
• b. All lesions on any one part of the body are at a similar stage and are about the same size.
• c. The rash of modified smallpox progresses through the stages more rapidly and has fewer lesions.
• d. Asymptomatic cases are difficult to diagnose but exceedingly infectious.

23. A rash concentrated on the face and distal extremities is likely:

• a. Smallpox (variola)
• b. Chickenpox (varicella)

24. A rash appearing in crops with lesions in different stages of evolution on any one part of the body is:

• a. Smallpox (variola)
• b. Chickenpox (varicella)

25. The first lesions are oral, followed by rash on face or forearm:

• a. Smallpox (variola)
• b. Chickenpox (varicella)

26. A person can expect almost complete protection against smallpox if vaccinated within how many days of exposure?

• a. 2 to 3 days
• b. 4 to 5 days
• c. 8 to 10 days
• d. 12 to 14 days

27. The smallpox vaccine does not contain the smallpox virus and cannot give you smallpox.

• a. True
• b. False

28. The virus in the live-virus vaccines has never been known to cause symptoms.

• a. True
• b. False

29. Which statement is false about the smallpox vaccine?

• a. It is given intramuscularly in the thigh with a 20-gauge 3/4-inch needle.
• b. It is given using a two-pronged needle that is dipped into the vaccine solution.
• c. The needle is used to prick the skin 15 times causing 1–2 droplets of blood to form.
• d. It is usually given in the upper arm.

30. Which statement is false about a successful smallpox vaccination?

• a. A red and itchy bump forms at the vaccine site in 3 or 4 days.
• b. In the first week, the bump becomes a large blister, fills with pus, and begins to drain.
• c. A successful smallpox vaccination is called a take.
• d. The scab falls off in the third week, leaving no mark or scar.

31. Which statement about the various forms of smallpox is false?

• a. Modified-type smallpox most often occurs in previously vaccinated individuals.
• b. Pregnant women seem to be more susceptible to developing hemorrhagic-type smallpox.
• c. Flat-type smallpox occurs more frequently in children and is often fatal.
• d. Ordinary smallpox is less severe, with a 2% death rate.

32. Treatment for smallpox includes:

• a. High-dose steroids to reduce the inflammation and itching.
• b. Isolation to prevent transmission of the variola virus to nonimmune persons.
• c. Vitamin B₁₂ shots continued for at least one year.
• d. Monitoring for associated cardiac symptoms.

33. Personnel recently vaccinated for smallpox should wear personal protective gear when contact with body fluids may occur.

• a. True
• b. False

34. Which of the following is not a respiratory complication of smallpox?

• a. Emphysema
• b. Viral bronchitis
• c. Pulmonary edema
• d. Bacterial pneumonia

35. Historically, the expected fatality rate of smallpox was 30%. Why might the death rate be lower today?

• a. The population is generally vaccinated and thus resistant.
• b. The immunocompromised population is better protected.
• c. There are better care and treatment options than thirty years ago.
• d. Immunity against smallpox is increasing in previously vaccinated persons.