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Croup — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)CroupUSMLE Step 3

A 64-year-old underwent therapeutic thymectomy for thymoma 8 years ago and remains in remission. Essential travel to a yellow-fever-endemic region cannot be postponed. Which plan is most appropriate?

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Correct answer: D — Provide a medical waiver with strict mosquito-avoidance counseling

The best answer is “Provide a medical waiver with strict mosquito-avoidance counseling”. Thymoma denotes abnormal thymic immune function, and its yellow-fever-vaccine contraindication persists despite remote therapeutic thymectomy or apparent cancer remission. Unavoidable travel therefore requires counseling about infection risk, a formal waiver, and meticulous bite prevention. Yellow fever vaccination is contraindicated after a thymus disorder associated with abnormal immune-cell function, including thymoma, and this remains true after therapeutic thymectomy. If unavoidable travel creates exposure risk, provide a medical waiver and emphasize strict mosquito-bite precautions. The alternatives use a different threshold, timing, population, or intervention and therefore do not match the clinical facts presented.

Reference: CDC Yellow Book: Immunocompromised Travelers: https://www.cdc.gov/yellow-book/hcp/travelers-with-additional-considerations/immunocompromised-travelers.html