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Postoperative intra-abdominal abscess — USMLE Step 3 MCQ

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HardSurgeryPostoperative intra-abdominal abscessUSMLE Step 3

A 46-year-old man receiving rituximab-containing chemotherapy for lymphoma is bitten on the forearm by a bat that tests positive for rabies. He has never received rabies vaccine. The wound has been thoroughly irrigated. Which complete post-exposure regimen is appropriate?

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Correct answer: D — Give HRIG once now and rabies vaccine on days 0, 3, 7, 14, and 28, then confirm the antibody response

The best answer is “Give HRIG once now and rabies vaccine on days 0, 3, 7, 14, and 28, then confirm the antibody response”. Previously unvaccinated patients require wound care, human rabies immune globulin infiltrated around the wound with any remainder given intramuscularly away from vaccine, and active vaccination. Immunocompromise changes the usual four-dose vaccine series to five doses on days 0, 3, 7, 14, and 28, followed by testing for rabies virus neutralizing antibody because the immune response may be inadequate.

Reference: CDC: Rabies Post-exposure Prophylaxis Guidance: https://www.cdc.gov/rabies/hcp/clinical-care/post-exposure-prophylaxis.html