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Lead screening — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Lead screeningUSMLE Step 3

A 43-year-old construction worker presents 4 hours after a soil-contaminated puncture wound through his boot. Devitalized tissue is debrided. He cannot recall childhood vaccination and has no accessible immunization record. Which tetanus-prevention plan is most appropriate?

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Correct answer: D — Administer both tetanus toxoid-containing vaccine and tetanus immune globulin today

The best answer is “Administer both tetanus toxoid-containing vaccine and tetanus immune globulin today”. This is a dirty major wound in a person whose primary tetanus series is unknown. CDC guidance calls for both active vaccination and passive protection with tetanus immune globulin. Immune globulin does not establish future immunity, vaccine alone does not provide immediate protection, and antibiotics are not used specifically to prevent tetanus after a wound.

Reference: CDC Clinical Guidance for Wound Management to Prevent Tetanus: https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html