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Colon cancer surveillance — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Colon cancer surveillanceUSMLE Step 3

A previously unvaccinated 29-year-old wildlife rehabilitator is bitten deeply on the hand by a raccoon that escapes and cannot be tested. The wound is irrigated immediately, and she has no immune deficiency or vaccine contraindication. Which rabies postexposure regimen is most appropriate?

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Correct answer: B — Infiltrate immune globulin and give vaccine on days 0, 3, 7, and 14

The best answer is “Infiltrate immune globulin and give vaccine on days 0, 3, 7, and 14”. A bite from an unavailable raccoon is a qualifying exposure to a high-risk terrestrial reservoir. A previously unvaccinated immunocompetent adult receives meticulous wound care, human rabies immune globulin infiltrated into and around the wound with any remainder given intramuscularly, and four vaccine doses. Immune globulin alone, vaccine alone, shortened schedules, or symptom-based observation fail to prevent an almost uniformly fatal infection.

Reference: CDC Rabies Post-exposure Prophylaxis: https://www.cdc.gov/rabies/hcp/prevention-recommendations/post-exposure-prophylaxis.html