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Asplenia vaccines — USMLE Step 3 MCQ

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HardSurgery (Post-operative / Follow-up)Asplenia vaccinesUSMLE Step 3

A 44-year-old who underwent splenectomy 3 years ago presents with rigors and temperature 39.4°C. Blood pressure is 96/58 mm Hg, lactate is 3.1 mmol/L, and there is no focal source. Vaccinations are current. Which management is most appropriate?

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Correct answer: A — Draw cultures, then start intravenous ceftriaxone-based empiric treatment

The best answer is “Draw cultures, then start intravenous ceftriaxone-based empiric treatment”. Fever in an asplenic patient can progress rapidly to overwhelming sepsis, so cultures and broad empiric parenteral therapy cannot wait. Vaccines reduce but do not eliminate risk. Oral discharge therapy or vaccine administration is not acute sepsis treatment. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: American Society of Hematology Education Program, Prevention of Infection in Asplenia: https://pmc.ncbi.nlm.nih.gov/articles/PMC7727556/