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Adult immunization — ABIM Board MCQ

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HardInfectious DiseaseAdult immunizationABIM Board

Three adults develop diplopia, dysarthria, dry mouth, and symmetric descending weakness after sharing home-canned vegetables. They are afebrile and sensation is intact. Toxin testing through the state laboratory will take several days. What should be done now?

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Correct answer: C — Request antitoxin through public health while collecting confirmatory specimens

The best answer is “Request antitoxin through public health while collecting confirmatory specimens”. Adult foodborne botulism is a clinical emergency. Antitoxin neutralizes circulating toxin but cannot reverse toxin already bound at the neuromuscular junction, so delay reduces benefit. CDC advises immediate state-health-department consultation and antitoxin when the clinical assessment supports botulism, without waiting for specialized testing. Respiratory monitoring is essential but does not replace toxin neutralization; pyridostigmine, lumbar puncture, and IVIG are not definitive adult treatment.

Reference: CDC Clinical Overview of Botulism: https://www.cdc.gov/botulism/hcp/clinical-overview/