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Anorexia nervosa — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)Anorexia nervosaUSMLE Step 3

A 36-year-old will begin rituximab in 8 weeks and has never received recombinant zoster vaccine. Which schedule best completes vaccination while preserving the recommended interval before anti-B-cell therapy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give RZV now and dose 2 in 1 month, leaving about 4 weeks before rituximab

The best answer is “Give RZV now and dose 2 in 1 month, leaving about 4 weeks before rituximab”. The shortened two-dose RZV schedule permits dose 2 after 1–2 months when faster completion is advantageous. Giving dose 2 at 1 month both meets that interval and places it approximately 4 weeks before the planned anti-B-cell therapy, when immune response is more likely to be robust. Adults age 19 or older who are or will be immunosuppressed need two RZV doses. When faster completion is beneficial, dose 2 may be given 1–2 months after dose 1; for anti-B-cell therapy, administer a dose about 4 weeks before treatment. The alternatives use a different threshold, timing, population, or intervention and therefore do not match the clinical facts presented.

Reference: CDC: Shingrix in Immunocompromised Adults: https://www.cdc.gov/shingles/hcp/vaccine-considerations/immunocompromised-adults.html