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Cervical cancer screening — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Cervical cancer screeningUSMLE Step 3

A 28-year-old woman at 24 weeks of gestation has no history of varicella, two negative varicella IgG tests, and continuous household exposure to her child, whose chickenpox rash began 48 hours ago. She is asymptomatic. What is the best next step?

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Correct answer: B — Administer varicella-zoster immune globulin today and arrange clinical follow-up for symptoms

The best answer is “Administer varicella-zoster immune globulin today and arrange clinical follow-up for symptoms”. She is susceptible, the household contact is a significant exposure, and pregnancy both raises complication risk and contraindicates live vaccine. VariZIG reduces the likelihood or severity of disease and should not be deferred until symptoms appear. A susceptible pregnant patient with a significant varicella exposure should receive VariZIG as soon as possible and within 10 days because live varicella vaccine is contraindicated during pregnancy.

Reference: CDC: Clinical Guidance for People at Risk for Severe Varicella: https://www.cdc.gov/chickenpox/hcp/clinical-guidance/index.html